Treatment of Unconsummated Marriage in Psychogenic Erectile Dysfunction among Iranian Couples
Urology Journal,
Vol. 23 No. 02 (2026),
20 June 2026
,
Page 73-79
https://doi.org/10.22037/uj.v23i00.8666
Abstract
Purpose: Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples.
Materials and Methods: A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple’s therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software.
Results: All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = −.314, P = .001), erectile function (r = −.361, P = .003), intercourse satisfaction (r = −.365, P = .003), and overall satisfaction (r = −.266, P = .031). Similar negative associations were observed for female age with overall ED (r = −.371, P = .002), erectile function (r = −.354, P = .004), intercourse satisfaction (r = −.344, P = .005), and overall satisfaction (r = −.246, P = .047).
Conclusion: Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.
- unconsummated marriages
- erectile dysfunction
- psychological erectile dysfunction
- coitus
- : Diabetes; Erectile dysfunction; Gene
- couple therapy
How to Cite
References
1. Amini M, Ozgoli G, Azar M, Majd HA. The time of consummation of marriage and related factors in women visited at health care centers and hospitals of Shahid Beheshti University of Medical Sciences in Tehran 2009. Pajoohandeh J. 2011; 16:73-78.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text revision. Washington, DC: American Psychiatric Association; 2013.
3. Rosenbaum TY. Applying theories of social exchange and symbolic interaction in the treatment of unconsummated marriage/relationship. Sex Relat Ther. 2009; 24:38-46.
4. Farnam F, Janghorbani M, Raisi F, Merghati-Khoei E. Compare the effectiveness of PLISSIT and sexual health models on women’s sexual problems in Tehran, Iran: A randomized controlled trial. J Sex Med. 2014; 11:2679-2689. doi:10.1111/jsm.12659
5. Murugan S. Unconsummation of marriage. J Psychosex Health. 2021; 3:283-285.
6. Silvaggi M, Michetti P, Fabrizi A, Rossi R, Tripodi F, Simonelli C. Is “unconsummated marriage” still an appropriate term? A snapshot of reality. Klin Psihol. 2016;9.
7. Bokaie M, Khalesi ZB, Yasini-Ardekani SM. Diagnosis and treatment of unconsummated marriage in an Iranian couple. Afr Health Sci. 2017; 17:632-636. doi:10.4314/has. v17i3.9
8. Foroutan SK, Jadid-Milani M, Mazloomi koohbanani S. Demographic categories of female visiting the Family Health Clinic of Shahed University in 2006 to 2015. Presented at: National Congress of Family and Sexuality; Tehran, Iran.
9. Özdemir Ö, Şimşek F, Özkardeş S, Incesu C, Karakoç B. The unconsummated marriage: Its frequency and clinical characteristics in a sexual dysfunction clinic. J Sex Marital Ther. 2008; 34:268-279.
10. Xi Y, Xia T, Colonnello E, Wang C, Lai Y, Zhang Y. Unconsummated marriage among Chinese couples: A retrospective study. Sex Med. 2023;11: qfac003. doi:10.1093/sxmed/qfac003
11. Krishnappa P, Jayaramaiah S, Sadashivan A, Matippa P. Unconsummated marriage: Findings and outcomes of couples visiting an andrology clinic. J Sex Med. 2023;20(suppl 1).
12. TM R. A critical assessment of the experiences and perceptions of the couple in an unconsummated marriage. Thesis. Stellenbosch University; 2005.
13. Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER survey: Implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013; 10:2232-2241.
14. Cera N, Di Pierro ED, Ferretti A, Tartaro A, Romani GL, Perrucci MG. Brain networks during free viewing of complex erotic movie: New insights on psychogenic erectile dysfunction. PLoS One. 2014;9: e105336.
15. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile dysfunction in young men: A review of the prevalence and risk factors. Sex Med Rev. 2017; 5:508-520.
16. Cuzin B, Cour F, Bousquet PJ, et al. Guidelines for general practitioners for first-line management of erectile dysfunction (updated 2010). Sexologies. 2011; 20:23-35.
17. Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: What can be expected? Asian J Androl. 2015; 17:5-10.
18. Riley A. The role of the partner in erectile dysfunction and its treatment. Int J Impot Res. 2002;14: S105-S109.
19. Ciaccio V, Di Giacomo D. Psychological factors related to impotence as a sexual dysfunction in young men: A literature scan for noteworthy research frameworks. Clin Pract. 2022; 12:501-512. doi:10.3390/clinpract12040054
20. Yafi FA, Jenkins L, Albersen M, et al. Erectile dysfunction. Nat Rev Dis Primers. 2016; 2:16003.
21. Mulhall JP, Levine LA, Jünemann KP. Erection hardness: A unifying factor for defining response in the treatment of erectile dysfunction. Urology. 2006; 68:17-25.
22. Banner LL, Anderson RU. Integrated sildenafil and cognitive-behavior sex therapy for psychogenic erectile dysfunction: A pilot study. J Sex Med. 2007; 4:1117-1125.
23. Campbell JD, Trock BJ, Oppenheim AR, Anusionwu I, Gor RA, Burnett AL. Meta-analysis of randomized controlled trials assessing low-intensity shockwave therapy for erectile dysfunction. Ther Adv Urol. 2019; 11:1756287219838364.
24. Tang Z, Li D, Zhang X, et al. Comparison of the simplified International Index of Erectile Function (IIEF-5) in patients with erectile dysfunction of different pathophysiologies. BMC Urol. 2014; 14:1.
25. Safarinejad MR. Prevalence and risk factors for erectile dysfunction in a population-based study in Iran. Int J Impot Res. 2003; 15:246-252.
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