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This case report discusses a couple who presented with a 22-year unconsummated marriage, due to penetration phobia in the female partner. The couple did well with sex education and therapy. The case is discussed in its various aspects and with a cultural background.
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We describe the treatment of sexual problems by Members of the Institute of Psychosexual Medicine who are trained to recognise and use therapeutically the doctor-patient interaction. A prospective study of long-standing cases of nonconsummation was chosen for evaluation of therapy as there was a definite outcome. Of 50 couples, most of whom had previously had many unsuccessful consultations, 64 per cent consummated within six months and 72 per cent in 14 months. Among those who had failed actually to consummate at six months, one third had increased their ability to enjoy sexual activity. The average number of attendances was six, involving altogether about four hours' work. These findings compare well with those reported in other studies and suggest that referral of such cases to a doctor specially trained in brief psychosomatic therapy tends to bring the best results.
A prospective study of the treatment of unconsummated marriage was carried out by 16 doctors trained by the Institute of Psychosexual Medicine. This training stresses the development of skills in using the doctor/patient interaction therapeutically, rather than in the acquisition of knowledge. The 159 couples admitted to the study had a mean duration of symptoms of 4.2 years; 60% of them had consummated by 6 months and 72% by 24 months. Other improvements in sexual function occurred even among those failing to consummate; 135 couples had previously consulted 253 other agents. The average cumulative length of treatment at the 6-month review was 3 h. Partners attending alone did as well as couples who attended together.
This is a prospective study of 150 consecutive outpatients who were either married or divorced. Marriage custom in Saudi Arabia is unique to the culture of that country and several different kinds of marriage are identified: arranged marriage of cousins; marriage of a couple who have not met before consummation; marriage of a couple who have met once before consummation; forced marriage; and, rarely, marriage preceded by a period of courtship. Marital discord defined by the patients as fully or partially responsible for their presenting symptoms, was correlated with the different kinds of marriage. Discord was found to be more likely when the couple had never met or when there had been a period of courtship; more likely associated with anxiety and dysthymic disorders; and to affect females more than males. Polygamy was a definite stress. The consanguinous marriage had a higher rate of marital discord than the non-consanguinous, but this was found to be not statistically significant. In 40% of discordant, consanguinous marriages the discord was directly related to the degree of consanguinity.
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This paper examines age patterns of first marriage and motherhood and covariates of early marriage, delayed consummation of marriage and early motherhood in Nepal using data from the 2000 Nepal Adolescent and Young Adult Survey (NAYA). Both unmarried and married male and female youths (age 14-22) were included in the survey. The analysis is based on 2800 urban youths and 5075 rural youths with complete information on the variables examined. Proportional hazard models are used to estimate covariates of early marriage and early motherhood, and logistic regression models are used to estimate covariates of delayed consummation of marriage. The results show that early marriage and early motherhood are quite common among Nepalese women, especially in rural areas. Early marriage is much less common among men. Delayed consummation of marriage is common among very young brides, especially in rural areas. The main covariates associated with early marriage and early motherhood are respondent's education, region of residence and ethnicity. The main covariates of delayed consummation of marriage are age at first marriage, region of residence and ethnicity. The study highlights the need to focus on less educated female youths in the Terai region in order to reduce the reproductive and child health risks associated with early marriage and early childbearing.
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A prospective study of cervical dysplasia cases and control cases matched for age and parity was undertaken in search of factors related to cervical carcinogenesis. Cytologic examination of 66,736 women revealed negative findings in 28.5%, inflammation in 70.3%, dysplasia in 1.4% and carcinoma in 0.1% of the cases. Data on epidemiologic features, cytomorphologic characteristics and serologic findings of antibodies to herpes simplex virus (HSV) were collected for proven cancer patients, dysplasia cases and control subjects. Cancer patients revealed significantly elevated antibodies to HSV as compared to the controls. The analysis revealed a higher proportion of dysplasia cases with an age at consummation of marriage of less than or equal to 15 years as compared to controls, with a relative risk of 1.5 (P less than .05). Similarly, a higher proportion of women with dysplasia had HSV-II-specific antibodies as compared to control women. The relative risk was found to be 1.3, which was not statistically significant (P greater than .05). The Mantel-Haenszel summary relative risk between antibodies to HSV and the two groups (dysplasia cases and controls), adjusted for the age at consummation of marriage, worked out to be 1.38, which was also statistically not significant (P greater than .05). The overall progression rate of dysplasia to malignancy was found to be 11.7% at the end of 54 months (during a total follow-up period of 84 months). Progression to cancer was highest in severe dysplasia cases and less in mild dysplasia cases. The progression rates were also significantly higher in the group of women who revealed antibodies to HSV II. Similar differences in the progression rates were observed with regard to the age at consummation of marriage.