Mumbai Mirror
08 January 2009

Dr Rajan Bhonsle gives ten most common reasons that stop couples from consummating their marriage
1. Lack of emotional involvement
Many women carry an apprehension regarding sex and hence, are unable to respond comfortably during the first few attempts of intercourse. This may also happen due to lack of emotional involvement in the relationship, especially if it's an arranged marriage. A woman's sexuality is usually 'heart-oriented'. It is best to wait a little and do not rush things.

2. Penetration phobia
Irrational fear or phobia associated with penetration is often a cause of nonconsummation of marriage, even in educated couples. The cause is a deep rooted psychological fear related to the genitals, mostly due to physical and/or psychological trauma in the earlier years. It may also be a learned fear caused by listening to myths about painful penetration during the impressionable years. Due to this, the woman rejects all attempts of penetration made by her partner.

3. Dyspareunia
There are several possible causes for dyspareunia, better understood as pain during intercourse. The problem arises because the woman's pelvic muscles may be too tight, or her vagina may not be adequately lubricated. Also, her hymen may still be partially intact which may be causing pain. It is strongly recommended that couples avoid having intercourse until the cause of this pain is found, or else things may only get worse. In later stages, a physical problem may become a psychological one.

4. A tight hymen
The hymen is a thin membrane that covers the vagina. It may or may not be present at birth. In some women the hymen is extra thick and tight. This makes it either impossible to penetrate during intercourse. Also, it may cause severe pain and bleeding if penetration is forcibly attempted. If a gynaecologist finds the hymen to be unusually tight on examination, a small surgery - hymenectomy - may be necessary before the couple attempts intercourse.

5. Vaginismus
Vaginismus is an 'involuntary spasm' of the muscle controlling the entrance to the vagina during attempts of penetration that invariably causes pain and discomfort. The cause is a deep rooted psychological fear related to the genitals. The woman involuntarily tightens the muscles of her vagina, making penetration painful and impossible.

A woman may or may not be consciously aware of the root cause. No medication can help in such a situation. A sex therapist trained in counselling and psychotherapy is better equipped to deal with it.

6. Psychogenic erectile dysfunction
Erectile Dysfunction is the inability to achieve or maintain an erection. In majority of cases, the cause is psychogenic, such as stress, anxiety, guilt, anger, mood disorders, relationship difficulties and past traumatic events. The treatment depends on the cause. Sex counselling and therapy is needed for psychogenic causes.

7. Organic erectile dysfunction
Whenever a man is unable to attain or maintain erection of penis (and thus unable to consummate his marriage) due to biological causes, it is called as organic erectile dysfunction. Organic causes may include endocrine conditions such as diabetes (50 per cent of diabetic men suffer from ED), disorders of pituitary, thyroid or adrenal glands, diminished testosterone levels, reactions to certain medications especially hypertension medications, and many more.

8. Performance anxiety
Fear of failure or anxiety about impotence ranks first in order of prevalence, in all the sexual fears that men bear. Ironically, the fear itself is the greatest cause of impotence and thus nonconsummation of marriage.

If a man is more focused on how well he is performing with a partner, rather than on enjoying the sensations in the sexual act, it may be difficult to attain or maintain an erection. This can become a vicious cycle. The remedy is to learn to relax. A couple needs to know that there is no possible way that a man can have an erection at will. When a man is involved in foreplay, without 'examining' the organ, erection happens on its own. The wife's cooperation plays a very important role in getting over such psychogenic impotence.

9. Premature ejaculation (pe)
pe is the most common complaint amongst men. It is not a physical problem, but a 'learning disability' found very commonly in newlyweds. Ejaculating early is a 'learned reflex response' that can be effectively re-conditioned when a man and a woman actively learn ejaculation control together. The 'squeeze technique' or the 'stop-start technique' can benefit in this case.

10. Fsad
fsad stands for Female Sexual Arousal Disorder. Female arousal is as much necessary as male erection for a couple to engage into intercourse. The physical causes of the same include many hormonal, and other organic causes that cause erectile dysfunction in men.

Psychological issues that contribute to Fsad are physical or psychological abuse, low self-esteem or distorted body image. Unrealistic expectations from the partner and unresolved emotional and relational issues in the couple also can cause Fsad. Certain medications can also impair female sexual arousal.