Menstuff® has compiled the following information on
Facts and Myths about An Often
Unspoken issue Unconsummated Marriages
One area that still remains in the closet, however, is that of unconsummated marriage. When I mention my role in treating couples that have never had sexual intercourse, to lay people, doctors and even mental health professionals, many are truly shocked to hear that such a phenomenon even exists. While statistics regarding the prevalence of unconsummated marriage arent documented, it has been estimated that 1% of all couples presenting to infertility clinics had not consummated their marriage. A colleague in South Africa recently reported that in the week following a TV segment aired on the subject, she received no less than 200 emails and phone calls from couples anxiously seeking treatment.
The causes of an unconsummated marriage can be varied, and complex. The reasons that a couple have for never having intercourse range from simple lack of sexual education and actual inability to determine how, to sexual dysfunction of the man, woman, or both partners. Some partners may not be sexually active at all, whereas others do everything but actual penetration and find satisfying ways to be intimate without intercourse.
Some couples may be perfectly satisfied with this arrangement, and may have even purposefully sought out a like minded partner, as in the case of Lisa, an Orthodox Jewish lesbian and Josh, a homosexual, who, due to deep religious conflicts regarding homosexuality and a deep commitment to family and community have preferred to remain in the closet, and build a celibate life together with their two adopted children.
Most couples, however, are dismayed to find they are unable to have sexual intercourse, whether their first attempts to do so were prior to, or after the marriage. Often, simple embarrassment prevents them from confiding in or consulting with anyone, thus perpetuating the condition, often for several years.
Many people believe that unconsummated marriages are more common in faith-based communities, where sexual intercourse is postponed until marriage. The assumption is that sexual intercourse among the deeply religious is considered bad and even once they are married, the couple cant get over the previous patterns of avoiding sexually arousing activities that could get out of hand. While in many cases, guilt regarding sexuality may inhibit sexual performance, the assumption that religious couples have more sexual problems may be completely unfounded.
Unfortunately, statistics are not available to determine whether unconsummated marriage is more common in religious populations. While many practitioners report that they see more religious couples presenting with unconsummated marriage, it is likely that it is precisely a strong sense of family values, monogamy and desire for a traditional marital sexual life that may prompt religious couples to seek treatment, and to do so sooner than their secular counterparts. The fact is that in Orthodox Judaism, for example, sexual activity between a man and wife is viewed as a positive commandment, and consummation of marriage is expected on the wedding night or shortly thereafter. Orthodox Jews are far more likely to seek help early on, as a sexual relationship that excludes penile-vaginal penetration presents difficulties regarding ejaculatory restrictions, and hinders procreation, an important Jewish value.
One factor that does appears to contribute to unconsummated marriage in particular and sexual dysfunction in general in faith-based communities, is a lack of premarital sexual education, insufficient understanding of female and male anatomy and physiology, and a strong sense of modesty, which may inhibit sexual behavior. Take the case of Katherine and Bruce, age 22 and 24 years respectively who presented to me after 2 years of marriage. Katherine tearfully reported that every time they attempted intercourse, she would experience severe pain, and would push Bruce away. Bruce reported that he felt rejected by Katherine and confused as to why he couldnt make love to his wife. Katherine and Bruce, both Catholics, waited to have sex until after the wedding, and though Katherine had never in her life even inserted a tampon or underwent a gynecological exam, neither anticipated that sexual intercourse would present a problem. What frustrated Katherine the most, she reported, was the reaction of the doctor to whom she presented with her problem. After a brief exam with which Katherine did her very best to cooperate he remarked there is nothing wrong with you, just drink some wine before and relax.
After taking a thorough history and examining Katherine, I explained to the couple that Katherine presented with vaginsimus. Simply having a word to describe her problem already helped her to feel better if only by validating what she had been experiencing. While vaginismus has classically been described as a reflexive muscle spasm of the vagina it actually is a problem that involves more than the vagina, and is a problem not only with sexual activity, but any activity involving penetration or attempted penetration in to the vagina. Vaginismus describes a situation where anxiety and fear of pain regarding vaginal penetration, is coupled with a physical reaction whereby the woman closes her legs, tightens her pelvic floor and surrounding muscles and simply resists the activity, even when she clearly wants to allow it.
Katherine and Bruce were reassured that they could get over their difficulties. Treatment for Katherine was initiated with physical therapy. The treatment consisted of showing Katherine her vulva in the mirror so she could learn her own anatomy and where to find her vaginal opening, as well as overcome her feelings of shame and embarrassment regarding her genital area. . She was taught relaxation techniques such as deep breathing to help overcome the feelings of panic and eventually was able to insert a small object, called a dilator, about the size of a tampon in to her vagina. She worked with gradually larger dilators, inserting them herself, as well as allowing Bruce to insert them. She also learned to relax and strengthen her pelvic floor muscles using biofeedback, a device that allowed her to see and control her muscles by watching their activity on a computer screen.
After six weeks of treatment, Katherine and Bruce reported that they succeeded in consummating their marriage. They called again a year later to proudly announce Katherines pregnancy.
While the story of Katherine and Bruce represents a classic and fairly easy to treat case, many times cases of unconsummated marriage are far more complicated, involve dysfunction by both partners, and require the intervention of a team of practitioners.
Rena, 42 and Josh 45 had been married 8 years but lived together 3 years prior to marriage. After an 11 year relationship, and anxious to get pregnant, they still had not had sexual intercourse. Rena, like Katherine, presented with vaginismus and was treated in physical therapy as well. Treatment for Rena, however, took longer, and it became evident that in addition to penetration anxiety, Rena had anxieties and phobias that restricted her function in several areas. She also displayed aspects of obsessive-compulsive behavior and was deeply disturbed by the feel of vaginal secretions, lubricant oils and gels, and semen. For his part, Josh, had difficulties keeping an erection.
After initially evaluating Rena and Josh, several referrals were made. Rena was referred to a psychiatrist who recommended medication to treat her obsessive-compulsive disorder and her anxiety. Rena also continued individual therapy, which she had been doing for several months, although the sexual issues had only recently been addressed. Rena and Josh were also referred to a sex therapist specializing in couples therapy. Rena and Josh had found ways to make love without vaginal penetration, but in the past few years, their sexual relationship suffered and they rarely were intimate. Sex therapy focused on breaking old patterns in which they had become entrenched, reestablishing their emotional and physical connection to each other through improved communication and sensual touching techniques and helping them move past their anxieties regarding both their previous failures at attempted intercourse, and the implications of altering their status quowith potential success. Joshs erectile dysfunction was addressed as well, both by the sex therapist, and with his urologist.
After nine months of team-oriented therapy, Rina and Josh consummated their marriage and commenced a satisfying intimate and sexual life together.
These are only two examples out of hundreds of cases seen in our clinics yearly. While successful treatment is available for this most painful situation, it is still shrouded in silence, embarrassment and discomfort, even by many members of the medical profession. Its time for unconsummated marriages to come out of the closet.
Laumann, EO, Paik A Rosen RC. Sexual Functioning in the United States. JAMA 1999; 281: 537-544
Leiblum, S, Definition of Womens Sexual Dysfunction Reconsidered: Advocating Expansion and Revision Proceedings of the Amsterdam ISSWSH meeting Oct 2003
MacIntosh, Elna November 2003, personal e-mail communication
Philipp, et al. BJSM, 15:3, 84-87 March 1988
Ribner, D, Rosenbaum T Evaluation and Treatment of Unconsummated Marriages in Orthodox Jewish Couples. Manuscript submitted for review, 2003
Source: www.newshe.com/articles/article_retrieve.php?articleid=124, Talli Yehuda Rosenbaum, www.physioforwomen.com