Unconsummated Marriage

Unconsummated Marriages hindering Conception and Pregnancy.
(Abstract of research paper presented at the 22nd World Congress of Sexology, Singapore July, 2015)

 Dr. Kunjappan Promodu

ABSTRACT

Inability to consummate the marriage, usually suffered by the newly wedded couples, has been one of the most common sexual problems hindering conception and pregnancy. Unconsummated marriage can be defined as the inability to engage in successful coitus within the marital dyad.

Unconsummated marriage is a devastating condition with far reaching psychosocial consequences for the couples and families. Many couples continue to suffer for several years with the inability to give birth to a child and a few end up in divorces. The oldest case of unconsummated marriage evaluated successfully treated at Dr. Promodu’s Institute of Sexual & Marital Health Pvt. Ltd was of 21 years duration. 

We evaluated a total of 15,357 patients comprising 13402 males and 1955 females sought treatment for sexual problems at Dr. Promodu’s Institute of Sexual and Marital Health Pvt. Ltd from 01^st February 2006 to 31^st January 2015. Patients belong to various diagnostic categories comprising of different age groups, genders, marital status, socio economic background, languages, cultures, hailing from different parts of the country. Evaluation was done based on case history, clinical interview, physical examination, laboratory investigations and imaging procedures. Male, female and combined factors were found to be responsible for non-consummation of marriage. Among the male factors erectile dysfunction was found to be the top ranking cause accounting for 79.37% followed by premature ejaculation 12.01%, Lack of sexual desire 3.92%, homosexual orientation 2.79%, sexual aversion disorder 1.31% and disorders of sexual preference 0.61%. Among the females vaginismus was the commonest cause accounting for 95.23% followed by sexual aversion disorder 2.46%, sexual desire disorder 1.85% and lesbian orientation 0.46%. Marital discord was found in 12.22% of the couples.

Unconsummated Marriage
Unconsummated marriage is an inability of the married couple to engage in a successful coitus or intercourse. Usually the newly wedded couples are suffering from unconsummated marriage. Unconsummated marriage has been one of the most common sexual problems with far reaching psychosocial consequences suffered by the married couples in Kerala and India as a whole. Unconsummated marriage cause severe marital distress, frustration, depression and anxiety for the couple. Gradually it leads to adjustment problems and hostility between the couple and may even end up in divorce. They may be ignorant and inhibited about sexuality. Sometimes either of them might have had experience of coitus with another mate, but unable to perform with the index partner. Usually in our culture husband and wife may not have any experience in penetrative intercourse before marriage.

Unconsummated marriage is also referred to as ‘honeymoon impotence’. Most of the couples are reluctant to seek immediate medical help. As the parental pressure or pressure from the family, friends and relatives mounts up for a child, they may consult a gynecologist with vague complaints. Gynecologist may find an intact hymen on examination. Most of the gynecologists advise hymenectomy (Removal of hymen by operation) and many females with unconsummated marriage may undergo hymenectomy. But it will not help most of these patients to solve their real problem. Even the attempt of gynecological examination by a little coaxing or force may aggravate the fear and worsen their problem. If the hymenectomy does not provide the couple desired recovery it often worsen their feeling of sexual inadequacy adding further distress. Unconsummated marriage is a devastating condition with grave consequences for the couples and families.

Many couples continue to suffer for several years and a few end up in divorces. At Dr. Promodu’s Institute of Sexual & Marital Health Pvt. Ltd, the oldest case of unconsummated marriage successfully treated was of 21 years duration followed by another case of 15 years and 3 months duration.  If left untreated it may persist for life long.

Our Data

We evaluated a total of 12,718 new cases at Dr. Promodu’s Institute of Sexual and Marital Health Pvt Ltd, Kochi, Kerala, India from 31^st January 2006 to 31^st January 2012. Out of them 10,977 patients comprise of 9,605 (87.5%) men and 1,372 (12.5%) women had sexual problems. Out of these 12718 cases 1926 that is 17.54% were suffering from unconsummated marriages.

Figure shows the percentage of cases with unconsummated marriages

Causes of Unconsummated Marriage 

Our research at Dr. Promodu’s Institute shows that various kinds of Sexual dysfunctions suffered by either the husband or wife or both may be the cause of unconsummated marriage. Erectile dysfunction and premature ejaculation suffered by the husbands and vaginismus suffered by the wives are found to be the most common causes of unconsummated marriage in India.

Treatment of Unconsummated Marriage

Our clinical experience at Dr. Promodu’s Institute shows that all cases of unconsummated marriages can be successfully treated if the couple is willing to cooperate. Till 31^st January 2013 we have successfully treated 961 couples with unconsummated marriages most of them are blessed with children.

Treatment depends on the nature of each couple’s problem. Treatment of unconsummated marriage includes medicines, sex therapy, operation or a combination of any of these methods. Unconsummated marriage is a condition in which 100 percent cure or recovery can be assured if the couple is willing to undergo the treatment.

Case History of Unconsummated Marriage

The agony and ecstasy of a priceless gift (Now - 27.8.2016 - this couple got two children)

Her eyes filled with tears of joy, Sery was most excited. Her son’s first birthday! Sery and Muthu with son Sefin dropped in to my consultation room on June 4th, driving all the way from Bangalore just to share this moment of immense happiness and gratitude.  My mind flashed back into memory lane. It was on a rainy day in June, Sery entered my consultation room with drooping eyes, emotionally dismayed and fumbling for words. Muthu feebly explained their pathetic history. Married on 21^st May 1993, they visited the institute 15 years later, on 18^th June 2008 with history of unconsummated marriage.

During the honeymoon days Muthu thought that it is but natural for any woman to have fear for sex. He waited a long…. almost two years before taking her to a doctor in Thalassery. Sery was obviously nervous and scared of the very thought of a doctor examining her genitalia. Doctor reportedly got annoyed as the attempt to do pelvic examination was futile. They didn’t go for further check up thereafter. About 9 months later, consulted another gynecologist who also didn’t succeed. Then the doctor examined her under general anesthesia and told Muthu that “Sery is perfectly normal, she doesn’t have any physical abnormalities, but suffering from anxiety and fear. It is a psychiatric problem. Probably a good psychiatrist may be able to help”. Being reluctant to consult a psychiatrist, they met a self proclaimed hypnotherapist and underwent hypnosis. But the result was disappointing. Then they consulted a professor of psychiatry who unsuccessfully treated with medicines for nearly six months. As a last resort a narcoanalysis was performed that did not reveal anything special. The doctor reportedly advised the husband “She is under sedation, probably you can try now”. Muthu found his loved one fast asleep and could not get any mood to try. Psychiatric treatment ended there. Deeply doomed by a series of failures, Sery thought of ending her life, requested Muthu to divorce her so that he could proceed with a second marriage. Their mutual love was so deep that Muthu could not dream of such a step.

In 2005 they visited a counsellor, but had to give up soon when the counsellor misbehaved which further accentuated her plight. Six months later a family friend advised them to meet a religious person in Kuttipuram. One full night of black magic including whipping was done to drive the evil spirit out of her body. Her agony and misery were unparalleled.

It was in June 2008 another friend knowing their tragic story, suggested Muthu to consult at Dr. Promodu’s Institute after detailed enquiries. Thus they reached the hospital on 18^th June 2008. Within two days we finished our evaluation of the husband and wife by our team of specialists and arrived at the final diagnosis. Sery has been suffering from vaginismus, which is a condition characterized by severe fear of injury, bleeding or pain and resulting in spasm of muscles that surround the vagina causing occlusion of vaginal opening. In such cases, penile entry is either impossible or painful. This was her actual problem which went undiagnosed / untreated for 15 years. Though a treatment module was prepared specifically for this couple they couldn’t undergo the same as Muthu had to go abroad on the very next day. The couple came back in June 2009 and completed treatment which lasted for nearly three weeks.  Sery had a marvellous recovery. Their life turned a full circle and she began to enjoy the ecstasy, conceived in the normal way and delivered in June 2012. After 19 years long waiting, for Muthu and Sery it was the God’s most priceless gift.

Strange are the ways of God and medical science!!!