{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T03:18:22Z","timestamp":1792639102806,"version":"4.5.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T00:00:00Z","timestamp":1699488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and\/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6\u00a0years and from 21 to 27.4\u00a0years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7\u00a0days to 3.5\u00a0years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths &amp; Limitations<\/jats:title>\n                  <jats:p>A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdad146","type":"journal-article","created":{"date-parts":[[2023,11,12]],"date-time":"2023-11-12T13:13:54Z","timestamp":1699794834000},"page":"20-28","source":"Crossref","is-referenced-by-count":12,"title":["Unconsummated marriage: a systematic review of etiological factors and clinical management"],"prefix":"10.1093","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9614-9218","authenticated-orcid":false,"given":"Pramod","family":"Krishnappa","sequence":"first","affiliation":[{"name":"AndroNeo, NU Hospitals Andrology Division, Department of Urology and Robotic Surgery, , Bangalore 560010 , India"},{"name":"Orchidz Health , Bangalore 560054 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Manfredi","sequence":"additional","affiliation":[{"name":"University of Campania Luigi Vanvitelli Urology Unit, Department of Woman, Child and General and Specialized Surgery, , Naples 80100 , Italy"},{"name":"Rush University Medical Center Department of Urology, , Chicago, IL 60612 , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sneha","family":"Jayaramaiah","sequence":"additional","affiliation":[{"name":"NU Fertility, NU Hospitals Department of Reproductive Medicine, , Bangalore 560010 , India"},{"name":"Orchidz Health , Bangalore 560054 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ditonno","sequence":"additional","affiliation":[{"name":"Rush University Medical Center Department of Urology, , Chicago, IL 60612 , United States"},{"name":"University of Verona Department of Urology, , Azienda Ospedaliera Universitaria Integrata, Verona 37126 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasanna","family":"Matippa","sequence":"additional","affiliation":[{"name":"AndroNeo, NU Hospitals Andrology Division, Department of Urology and Robotic Surgery, , Bangalore 560010 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupin","family":"Shah","sequence":"additional","affiliation":[{"name":"Lilavati Hospital and Research Centre Andrology Division, Department of Urology, , Mumbai 400050 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Moncada","sequence":"additional","affiliation":[{"name":"Hospital Universitario La Zarzuela Department of Urology and Robotic Surgery, , Madrid 28023 , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,9]]},"reference":[{"key":"2024010414220711300_ref1","article-title":"International Society for Sexual Medicine. 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