(088) Unconsummated Marriage: A Systematic Review of Etiological Factors and Clinical Management
Authors: Krishnappa P , Manfredi C , Jayaramaiah S , Ditonno F , Matippa P , Shah R , Moncada I 
Published: March 2024

Abstract

Introduction
Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse.

Objective
To systematically review current evidence regarding the etiological factors and clinical management of UCM.

Methods
A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples (S) who never had sexual intercourse (PI) in case report or case series (D) evaluating the related causes and/or management (E) and reporting data with qualitative, quantitative or mixed methods (R). Quantitative data were reported as found in the original studies. Evaluation of level of evidence and quality of studies were based on Oxford Centre for Evidence-Based Medicine 2011 and Murad scale, respectively. The review was reported according to PRISMA statement and registered in PROSPERO with ID CRD42023433040.

Results
A total of 27 studies including 1,638 males and 1,587 females were selected (Fig 1). Eight articles (29.6%) were case-report involving a single couple and 19 studies (70.4%) were case series. Mean (range) Murad score was 4.1 (1–8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of the studies were reported from Egypt (5, 18.4%), Israel (4, 14.9%), and USA (4, 14.9%) (Fig 2). Mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 studies (85.2%), inability to conceive in 1 article (3.7%), and mixed in 3 papers (11.1%). The mean duration of UCM before a medical visit varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4–81%) and ED (10.5–61%) were the most common causes of UCM. Three articles reported that 16.6–26% of all UCM cases were due to both male and female factors. Basic sex education was advised in all treatment programs. A multidisciplinary therapeutic approach involving urologist, gynecologist, psychiatrist, and physiotherapist was applied to 135 patients, achieving a consummation rate of 97%. Sildenafil 50 mg on demand for 1–3 months was used in the management of ED leading to a consummation rate of 84.6–100%. Tadalafil was prescribed both on-demand and daily, achieving consummation rates of up to 91%. Vaginismus was treated with desensitization sessions and graded vaginal dilators, leading to penetrative intercourse in 66.6–100% of cases after 1 month-5 years of therapy. Strengths & Limitations: The first systematic review covering the entire spectrum of UCM. The low quality of most of the included papers and the large percentage of UCM cases are probably not published.

Conclusions
ED and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

Disclosure
No.