Unconsummated Marriage or Relationship

Some couples are physically unable to have intercourse — that is, to "consummate" their relationship.  There are several possible reasons for this.

Sometimes couples simply lack basic information about their bodies and about how to be sexual.  Unfortunately, they may feel foolish, embarrassed, or inadequate.  This embarrassment then prevents them from seeking needed information.  Or information may be hard to come by.

Some women have vaginismus, a tightening of the vaginal muscle, which prevents penis-vagina intercourse.  If a man pushes hard trying to enter, it can cause the woman intense pain.  In other cases, vaginismus is due to a medical condition that causes pain in the vulvar area, inside the vagina, or elsewhere in the pelvic region.  Tightening the pelvic muscles is an unconscious reflex effort to prevent further pain.

In other cases, vaginismus is caused by fear or aversion to sex.  For women who experienced sexual abuse, rape or other trauma, this may be an effort to protect themselves from further violation or pain.  Many women who are fearful or aversive to sex have no history of trauma, but may have heard scary stories about sex, learned negative sexual attitudes, or have frightening images relating to sex.

Other causes of unconsummated relationships include ejaculatory control problems or erection difficulties.  A man may be unable to enter his partner’s vagina because he ejaculates too soon or is unable to get and keep a sufficiently firm erection.  This can be caused by a medical condition that needs treatment by a physician.  For other men, the problem may be due to social, emotional or psychological concerns.  Even when caused by a medical problem, psychological counseling may be helpful to explore and resolve accompanying emotional reactions.

Sometimes one or both partners may lack interest in sex or have exceptionally low sexual desire.  They find it difficult to make sex happen.  If only one person is uninterested, the sexually interested partner may feel hurt, rejected or unattractive.  If both lack desire, it may only become a problem if they want to have a baby or if they feel the relationship is missing something.

In some cases, lack of sexual interest may be life long, but in others, it may result from depression, illness, medications, hormones or relationship problems.

Diagnosis and Treatment of Unconsummated Relationships 

The diagnosis of an unconsummated relationship might appear simple but a couple may be reluctant to tell their health care provider.  Careful questioning and complete answers are needed to understand the specific cause of the problem.  A caring gynecologist or sex therapist will work to establish a comfortable environment in which the couple can talk about their sexual relationship and what might be preventing intercourse. 

If the problem is caused by a lack of information, the sex therapist will help the couple get the information they need through discussion and readings.  Feelings and beliefs about sex will be explored, while individualized home assignments will help the couple feel more confident and relaxed.

When an unconsummated relationship is associated with erectile difficulty or early ejaculation, a sex therapist begins treatment with a careful evaluation.  The therapist will ask a variety of questions, such as how long this has been a problem, when it is not a problem, frequency of morning erections and so on.  If a medical cause is suspected, a referral is made to a urologist specializing in sexual problems.  If the evaluation suggests stress, relationship problems, lack of information or fear, then sex therapy is typically recommended.

Sex therapy for ejaculatory and erectile problems involves an individualized, step-by-step treatment program.  The therapist provides information, teaches relaxation, and helps the couple develop ways to please each other while learning to have better erections or last longer.  The couple, through assigned home practice exercises, will focus on enjoying touch without the pressure to have intercourse.  This will enable them to move toward their goals. 

If intercourse has not been achieved because one or both partners are uninterested in sex, the therapist will first ask about their sex histories, their relationship and their feelings and beliefs about sex.  The focus of therapy might be on the couple’s relationship, depression or anxiety, attitudes about sex, or  initiation of pleasurable touch that may lead to arousal and sexual activity.  Referral to a urologist or gynecologist specializing in sexual problems may also be appropriate.

For more information on sex therapy for vaginismus, click here.

For more information on sex therapy for aversion, panic or fear, click here.

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