Female Urology, Gynecology

The 1999 article in the Journal of the American Medical Association by Dr. Edward Laumann indicating that 31% of men and 43% of women suffer from sexual dysfunction raised awareness in both the medical world and the general population of the prevalence of sexual problems. Today, women?s magazines, popular internet sites and television program openly discuss sexuality, sexual health and sexual problems, from erectile dysfunction, to persistent arousal, and even the fact that many marriages are, essentially, sexless.

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 aren?t 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.