One of the pleasures that a newly married couples most look forward to is a happy and mutually satisfying sexual life. However, some couples are unfortunate at this. Failure to achieve this satisfaction, and worse being unable to have sexual intercourse at all can have a shattering effect on the marriage, resulting in marked stress, frustration, hostility and even divorce in some cases.

In our society a large number of couples entering into an arranged marriage and many of the love-marriage couples are virgins and have little and fragmented sexual knowledge. As a result, inability to consummate i.e. failing to establish a sexual relation is very common. Unfortunately, due to the secrecy surrounding this subject, the matter is rarely discussed. The hype created around this issue makes the situation worse for the partners and their parents when they come to know about this. They remain ignorant of the prevalence, causes and cures. It is not surprising to find that often the doctors are also not aware about the management. “It will take place on its own” or “It’s all in head” are some of the comments given which are certainly not useful to the partners. The problem persists like a hidden epidemic leading to broken marriages and ruined lives. The sad irony is that most of these problems can be treated effectively and the sorrow and suffering that the two young lives undergo can be avoided.


1. Ignorance : Many young couples, despite being well educated, are surprisingly ignorant about sexual matters. False expectations or incorrect technique can lead to failures and start off a negative cycle of performance anxiety and further failures.

2. Fear of pain : Many women approach their first encounter with a pre-conditioned notion that first sex is very painful. As a result, they have subconscious anxiety leading to the involuntary spasm of the vaginal introitus i.e. vaginismus, and intercourse becomes impossible.

3. Performance anxiety : similarly many men are the victim of numerous myths and misconceptions like masturbation guilt, penis size anxiety, worry about the ‘dhat’ etc. As a result of which they fear that they are sexually inadequate and will be unable to have intercourse. Thus, their first sexual experience with the wife is associated with severe performance anxiety, which leads to erectile failure.

4. Personality disorders : Some men and women have severe personality disorders characterized by phobias, deep rooted fears, depression and impaired social skills which affect not only their sexual relationship. In these cases the sexual disturbances is just one facet of a very disturbed marriage.

5. Physical defects : Sometimes the failure to achieve intercourse may be due to an actual physical problem that prevents intercourse. The woman may have dyspareunia due to a local inflammatory pathology. Rarely, the hymen may be very tough and would need dilatation.
Similarly, a man may have phimosis or severe penile curvature that makes penetration painful or difficult. Sometimes a man may have a congenital defect in the penile arteries or the veno-occlusive mechanism, resulting in inadequate erections. These men appear normal externally and only a detailed evaluation will reveal that the problem is a physical one.

6. Social factors : Family pressures, lack of privacy, job stress, can sometimes generate so much stress within the marriage that sexual intimacy is not possible.


It is very important that therapy is initiated as soon as possible. Many times they are told to wait and keep patience and things will be normal on its own. By the time they seek expert’s advice, there is so much frustration and hostility that therapy becomes difficult.

“Try and try until you succeed” is not applicable here because with every attempt when they fail, they loose confidence with themselves and that in the partner. Hence it is very important not to waste the time and the couple should be subjected to the therapy. In fact, non-consummation of the marriage should be considered as a semi-emergency.

In many cases all that is required is basic sex counseling to correct myths and misconceptions, allay fears etc. Simple suggestions like keeping at least dim light on and assuming proper positions helps them immensely to identify each others body parts to achieve successful penetration. When fear is the main problem, then, in addition to counseling the woman must be taught vaginal self-dilatation.

In some conditions, surgical operation - hymenectomy is required.

Often social counseling is also required to correct excessive interference by the in-laws, create privacy, minimize stress and improve interpersonal communication between husband and wife.

When the man’s performance anxiety is very severe, counseling alone is often not adequate. These men need temporary medical support to obtain adequate erections. Often many men are reluctant to start medication thinking sex should be natural or they will be addicted to the medication once they start. Actually, it is not so. Once they succeed in having intercourse a few times with the help of the medication, they gain confidence and are soon able to get a full erection naturally and have intercourse without the help of any medication.

If a man has a physical defect then surgical correction is required. This may involve circumcision, correction of penile curvature, penile revascularisation to bring more blood into the penis or , in severe cases, implantation of a penile prosthesis.

(For detailed information on treatment of various Male sexual problems and Female sexual problems – refer respective sections in this website)

While almost any kind of physical defect can be corrected, deep rooted psychopathology is often difficult to treat.

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