(270) Case Study - Couples Therapy - Impact of Sociocultural Factors in an Unconsummated Marriage
Authors: Malhotra U 
Published: May 2023

Abstract

Introduction
The dynamics of marriage are influenced by the social and cultural context. In the East, several unique factors impact the marital relationship. Culturally, sex education, dating and sexual experiences before marriage are uncommon – friends and pornography are the sources of information. Arranged marriages are frequent and families are involved in selecting partners. Couples enter marriage with limited knowledge and experience of sex; therefore, unconsummated marriages are not uncommon.

Objective
Case study of a couple in therapy to resolve an unconsummated marriage of 1.5 years by addressing relational, psychosocial and cultural factors.

Methods
History was taken using the Bio-psycho-social paradigm. •An arranged marriage with both partners working in the IT field • Met each other only a few times before marriage • Loss of erection when attempting penetration was the reason for seeking medical help. • No medical aetiology: the couple was referred to a sexologist. • The families of origin were an important part of the lives of both husband and wife. • Both partners hadn’t had any sexual partners before marriage. The husband masturbated a few times a week. • For the husband, erection and ejaculation were both possible with masturbation/partnered masturbation. Both partners would orgasm during foreplay. The wife was initially an unwilling participant in therapy. She felt providing sex was the husband's duty and since he wasn't able to have penetrative sex, he needed to sort his “issue.” She threatened to live separately till then. Her threat was anxiety-provoking, and every occasion of intimacy was one of anxiety and self-doubt about whether he could perform. He had had a long period of unemployment before marriage and that had been an anxious phase too. Therapy began with agreement that both partners would be involved in the therapeutic process and view the situation as a couple to work through together. Their communication was strained – anger outbursts from the husband and days of silence from the wife. The interaction with their respective families was significant and intrusive for the other partner. The first phase addressed patterns of communication and safety to have micro-conflicts. The next phase focused on their developing an identity as a couple and setting boundaries with their families. Intimacy was put on hold till the first 2 phases were worked through. Sex education was provided to both around orgasm, anatomy, penetration and mutual masturbation. The next phase focused on intimacy and experimenting beyond sex; the couple followed the steps of sensate focus.

Results
The nature of the relationship changed, a couple identity formed and there was comfort to have micro-conflicts. The bonding and psychological safety increased, and overall anxiety reduced. The lens of intimacy and pleasure was widened beyond penetrative sex. After working through four different phases of the therapeutic process, the couple consummated their marriage.

Conclusions
In marriages that are arranged, various sociocultural factors can impact the quality of the relationship. Establishing psychological safety, creating a boundary for the couple and providing sex education set the stage for the couple to experience physical intimacy in a conducive space.

Disclosure
No