When the man fails to consummate a marriage

Rose called me at 7am. She had just had a normal delivery to a bouncing baby girl.

"We have gone a full cycle; I am a mother; can you imagine it?" she shouted on the phone.

It had been two years since I met her. She was 34 then and her husband, Richard, was 36. They had been married for seven years but did not have a child.

Family pressure was building upon them to have a child and in fact, Richard's mum was threatening to get him another wife. "Have you seen any doctor to help solve the problem?" I asked.

They both went quiet. I could tell there was something deep and disturbing that they wanted to talk about.

"No, there was no need to see a doctor," Richard said. I did not understand. Something was not adding up. "We live like brother and sister!" Rose said, embarrassed.

I enquired further what this meant, and it turned out that the couple had never had sex in the seven years of their marriage. This was a case of an unconsummated marriage.

The epitome of unconsummated marriage is silence. The couple is in most cases embarrassed and does not tell what they are going through to anyone.

I took to exploring why after a glamourous wedding this couple remained celibate, ruling out one cause of this problem after another.

Failure to consummate a marriage can be because of problems in a man, woman, or both parties. If a man has anatomical problems of the penis - such as a curved penis - they may not be able to have penetrative sex.

ANATOMICAL PROBLEMS

In some cases, the anatomy is fine but erection just does not happen. Then there are cases of premature ejaculation. Once ejaculation happens naturally, the erection goes and penetrative sex cannot happen.

In the case of women, severe pain, especially the pain that comes in attempted penetration, is a common cause of an unconsummated marriage.

Vaginismus is the typical problem in these cases and is characterised by pain, fear, apprehension and tensing of muscles when penetrative sex is imagined or attempted.

In both men and women, sexual desire disorders can be the problem. In this case, one or both parties just have no urge for sex.

"I think in our case things just failed; we tried to have sex but it just could not work out," Richard said. I realised I would have to examine both of them to clarify further what the issue was.

As reality sinks in unconsummated marriages and couples notice that sex is not possible, a number of issues come to play that further complicates the situation.

Some partners may resort to masturbation or go into an extramarital affair. Communication may become difficult. Psychological stress can set in and some people slide into depression.

CONGENITAL CURVATURE

Social and cultural myths around sex may also become prominent. "Actually, this issue took a toll on us at some point and Richard even became violent," Rose reveals.

"But you also started visiting witchdoctors, which was against my values!" Richard shouted back.

I requested the couple to calm down and asked to examine both of them. Rose had normal anatomy. There was no sign that she had vaginismus as she was quite comfortable during the examination.

Women with vaginismus freak out at the imagination that their genitals are to be examined.

Richard, on the other hand, had an obvious curved penis. Unlike a normal straight penis, he had a 90-degree curve in the middle. There was no way penetrative sex could have been possible with such a defect.

I made a diagnosis of congenital curvature of the penis and referred Richard for corrective surgery.

It took almost a month for the wound to heal. The couple had then to undergo sex coaching. Having not engaged in penetrative sex, it was important to provide them with skills for a smooth start off.

By the third month, the couple had smooth intimacy. It took almost another 10 months for conception to happen. We had indeed gone a full cycle.