Non-Consummated Marriage India

Doctor, We are not sure we are doing it right

Clinical Relevance

Both are unsure as to what exactly is supposed to happen in an intercourse, hence are not sure how to achieve it

Therapeutic guidelines
  • Ensure normal erection
  • Explain Genital anatomy,
  • What is an intercourse & the necessary Coital position

Doctor, We have not been able to make it so far

Clinical interpretation

Both are aware that penetration has not yet occurred in their sexual relationship They have basic knowledge of sexual intercourse.

Therapeutic guidelines
  • Ensure normal erection
  • Explain anatomy & coital position

Doctor, She does not allow me

Clinical Relevance

He knows that his erection is no problem but penetration has not occurred as she is not allowing it . Probably even she is also aware of the fact but can’t help it

Therapeutic guidelines
  • Concentrate on female partner
  • Exclude vaginismus
  • Allay anxiety, fear of pain
  • Self-dilatation

I think I am impotent

Clinical interpretation

He is convinced that he is impotent
And that he alone is the cause of the non-consummation
High degree of performance anxiety
Has developed psychogenic ED

Therapeutic guidelines
  • Counsel the male, help him get rid of inferiority complex, ensure his erection with erectogenic drugs
  • Ensure female’s active participation

I am ok, but she does not feel it

Clinical Relevance

Subtle shades of a MCP- knows he gets erection, believes he penetrates because he can ejaculate. He is at a total loss to understand as to how she can not feel it

Therapeutic guidelines

Male – Make him understand that he can ejaculate inbet labia without penetration
Female – Positioning her pelvis to facilitate penetration, Self dilatation

My wife is upset; saying I need treatment

Clinical interpretation

The differences due to UCM are sharp but not yet irreconcilable. He probably has developed psychogenic ED

Therapeutic guidelines

Necessary to counsel the couple and assure the female that this problem is solvable. Also that she has equal role to play in solving it. And treat his ED.

I need a certificate of my potency as my wife has filed for divorce

Clinical Relevance

Too late, missed the bus Make sure whether he has ED-psychogenic or Organic

Therapeutic guidelines

Pharmacologically Induced Erection Test Nocturnal Penile Tumescence (NPT) Make sure he is capable of consummating his second marriage

We do not have a baby yet

Clinical interpretation

Supremely Ignorant couple ! Never doubted that what they were doing as sex was not an intercourse and expected a pregnancy out of it.

Therapeutic guidelines

Extensive psychosexual counseling Protocol for UCM

Protocol for the male

  • Assess Erectile Function by
    • Pharmacologically Induced Erection (PIE) test with Intra-Corporal Inj or PDE5 Inhibitor trial
    • NPTR ( Rigiscan)- Nocturnal Penile Tumescence & Rigidity
  • Therapeutic dose determination (TDD) of Either modality i.e. Oral or Self-Injection
  • Ensure sustained Erection with rigidity on demand

Drugs Used

  • Oral- PDE5 Inhibitors:
    • Sildenafil 50, 100 mg
    • Tadalafil 10 , 20 mg
    • Vardenafil 5 , 10 mg
  • Intra Cavernosally Injectable:
  • Papaverine + Phentolamine or Chlorpromazine Prostaglandin E1

IntraCavernosal Injection of VasoActive Drugs (ICIVAD)

STEPS
  • Therapeutic Dose Determination(TDD)
  • Supervised Injection Program (SIP)
  • Home Self-Injection Program (HSIP)
  • Wife-assisted Home Injection Program(WHIP)

Penile Prosthesis

Only when organicity is proved Inflatable & Non-Inflatable

Unsuitable Modalities

  • VED
    • Lacks spontaneity
    • Rigidity inadequate for the 1st penetration
    • Cumbersomeness causes more anxiety
  • Vascular Surgery
    • Delayed result
    • Uncertain outcome

Counseling the Couple

  • Explain the anatomy of Male & Female genitalia
  • Explain the need, by diagram, to tilt the pelvis to facilitate penetration
  • Diagrammatic coital positions which the couple can find comfortable
  • ASSURANCE of no pain to female
  • ALLAY the fear of failure of male

Non-Consummated Marriage India Non-Consummated MarriageIndiaAndrologist Consultant Andrologist Microsurgeon