(335) Unconsummated Marriage: Findings and Outcomes of Ccouples Visiting an Andrology Clinic
Authors: Krishnappa P , Jayaramaiah S , Sadashivan A , Matippa P 
Published: May 2023

Abstract

Introduction
Failure to have a penetrative peno-vaginal intercourse among the heterosexual married couples is termed as unconsummated marriage (UCM). Unheard in most western countries, UM is often seen in culturally conservative countries like India where majority still don't have sexual encounters prior to marriage. Nonconsummation is most commonly due to erectile dysfunction (ED, vaginismus or forced marriage. The management requires an aggressive early treatment otherwise some even end up in divorce.

Objective
To report the clinical characteristics and outcomes of males visiting Andrology clinic seeking treatment for UCM

Methods
This is a retrospective study of 62 male patients seeking treatment for UCM who presented to the andrology clinic from Jan 2018 to May 2022. All were subjected through detailed clinical history including patient demographics, physical examination and necessary investigations. Wherever possible, the female partner was also involved for discussion and if found abnormal during clinical history was referred to the female reproductive medicine specialists.

Results
Of the 62 male patients, majority (56, 90%) complained erectile dysfunction as the cause for UCM. Other causes being lack of anatomical knowledge of intercourse (2/62), vaginal pain while attempting penetration (4/62), performance anxiety (5/62) and forced marriage (4/62). There was overlap of more than 1 cause in few patients. The mean duration of UCM was 12.6 months (range 2-128 months). Of the 62 patients, 13 had master’s degree and 42 had bachelor’s degree. Among the 56 patients with ED, 22/56 had already received sildenafil or/and tadalafil from primary care physician with no success. Dual therapy (simultaneous on-demand sildenafil and daily tadalafil) helped 23/56 males to consummate their marriage. Six males didn’t come for follow-up after 2 visits and even refused to answer our questions on phone. Two males did not seek any further treatment for ED after oral medications failed and proceeded with assisted reproductive techniques to conceive for social reasons. Of the four females with vaginismus, 3 successfully consummated following vaginal dilator therapy and psychosexual counselling, but the remaining 1 proceeded with intrauterine insemination to conceive. Consummation was achieved in 6 men who received intra-cavernosal injection of reconstituted 20mcg alprostadil. Three men consummated following penile prosthesis placement (2 semirigid and 1 inflatable). Two couples divorced as the wives wanted “natural” erections from their husbands and not “medicated” erections. Three couples were in the process of divorce. Twelve of the 62 men were accompanied by their parents or in-laws in their first or second clinical visit.

Conclusions
As against the usual assumption, UCM is commonly seen even among the well-educated class. UCM should be considered as an andrological emergency and timely intervention is required to prevent termination of marriage. When oral medications and counselling doesn’t work, do not hesitate to start on intra-cavernosal injections and occasionally may be a penile implant surgery. Due to social and familial concerns, few may decide to seek assisted reproductive techniques to conceive without sexual intercourse and the same may be considered.

Disclosure
No