Diagnosis and treatment of unconsummated marriage in an Iranian couple

Unconsummated marriage: a systematic review of etiological factors and clinical management

BACKGROUND

Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse.

AIM

The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM.

METHODS

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.

RESULTS

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 years and from 21 to 27.4 years, 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 days to 3.5 years. 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%.

STRENGTHS & LIMITATIONS

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.

CONCLUSION

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.

Experience of individuals with unconsummated marriage in Iran: A qualitative content analysis

Background

Sex is one of the important aspects of marriage and a way of expressing intimacy. Unconsummated marriage is a common problem whose prevalence is about 1.5% in Iran and can significantly influence marital life.

Objective

This study aimed to assess the unconsummated marriage in a qualitative mode to offer new and beneficial solutions resulting from a better understanding.

Materials and Methods

In this qualitative study, conventional content analysis was used. Data collection and analysis were done from April 2013 to April 2014 with 11 women and 5 men participating, who were referred to the sexual disorders clinic of Tehran Psychiatric Institute and Rasool Akram hospital of Tehran, Iran. The researchers examined the files of people referred to these clinics with the diagnosis of unconsummated marriage. Our tool for data collection was a semi-structured interview. 2 experienced faculty psychiatrists recorded all the information based on standards for reporting qualitative research guidelines. Data were analyzed using qualitative technique and coding. Guba and Lincoln criteria was used for data validity.

Results

The codes of the participants' experiences were classified into 6 main categories, which include self-concept, intrapersonal factors, partner's problem, preparedness for sex, emotional relationship between couples, and the effects of unconsummated marriage on the participant's life.

Conclusion

Significant experiences among women included excessive anxiety toward the society and their spouses, and among men were weakness and guilt. Being unable to have sex negatively affected their view of life and caused great harm to their self-perception. Participants personality traits and their self-concept, and attitude toward their partners were important issues.

Sexual function among women with vaginismus: a biopsychosocial approach

BACKGROUND

Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder.

AIM

The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model.

METHODS

This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus.

OUTCOMES

Participants rated their determinants of sexual function based on the biopsychosocial model.

RESULTS

The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit.

CLINICAL IMPLICATIONS

This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem.

STRENGTHS AND LIMITATIONS

This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic.

CONCLUSION

Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.

Unconsummated marriage among Chinese couples: a retrospective study

Background

Unconsummated marriage (UCM) is a significant problem among couples who are unable to achieve successful sexual intercourse and penovaginal penetration, and the etiology and clinical characteristics of UCM in Chinese couples remain unknown.

Aim

In a retrospective analysis of patients with UCM, we investigated clinical characteristics and treatment outcomes among Chinese couples with UCM.

Methods

During the period from January 2019 to May 2021, we examined 127 consecutive couples with unconsummated marriage. The couples were evaluated separately by andrologists and gynecologists, and combined treatments were conducted by therapists.

Outcomes

We calculated the distribution of etiologies of UCM in Chinese couples.

Results

Among the couples whose data were evaluated, 93 couples visited the andrologist first and 34 couples visited the gynecologist first. The most common complaints associated with sexual dysfunction were erectile dysfunction (ED) in male patients and vaginismus and dyspareunia in female patients. Unconsummated marriage among Chinese couples was caused primarily by female factors (55.8%). With couple-oriented treatment conducted by sexual therapists, the success rate was 67.7%.

Clinical Translation

If a couple is diagnosed with UCM, both the husband and wife should be treated individually receive guidance from a sex therapist toward successful sexual intercourse.

Strengths and Limitations

This is to our knowledge the first report regarding the etiology of UCM in Chinese couples. Here we report our routine diagnostic and therapeutic workups. However, we were not able to perform hormonal and imaging studies of the female partners. Moreover, patients presenting with UCM who visited our department without a partner were not included in the statistics.

Conclusions

Unconsummated marriage among Chinese couples may be caused byfactors affecting both the husband and wife or the husband and wife individually; however, factors affecting women are the predominant causes of UCM. Lack of knowledge about sex-related issues, as well as cultural beliefs, play an important role. A preliminary evaluation by an andrologist and a gynecologist, followed by couple treatment conducted by the sex therapist, is highly `recommended to treat UCM effectively.

Bio-psychosocial factor of vaginismus in Iranian women

Background and aim

Various physical, psychological, social and cultural factors contribute to vaginismus. Therefore, given the multidimensionality of this disorder and the need to pay more attention to all biological, psychological and social dimensions in its treatment, the present study was conducted to investigate the bio-psychological factors contributing to vaginismus.

Methods

This descriptive cross-sectional study was conducted on 180 Iranian women with vaginismus who had been referred to sexual health clinics of Tehran province in 2020. Multistage random sampling method was used in this study, and vaginismus was diagnosed in women by a specialist through using a questionnaire. Data collection tools included demographic and obstetric information form, valid and reliable Sexual Function Questionnaire, Depression Anxiety Stress Scales (DASS), Sex Fear Questionnaire, Vaginal Penetration Cognition Questionnaire, Sexual Self-Efficacy Scale, Sexual Knowledge and Attitude Scale, Sexual Quality of Life-Female, Inventory of Sexual Satisfaction, ENRICH Marital Satisfaction Scale, Sexual Intimacy Scale and Questionnaire for Diagnosis of Vaginismus. In order to determine the factors related to vaginismus, multiple linear regression model was used through SPSS software version 25 (SPSS Inc., Chicago, IL).

Results

Based on the results of the present study, the mean age of women and the mean duration of their marriage were 27.77 ± 5.36 and 4.07 ± 3.87 years respectively. As the results of multiple linear regression revealed, the variables of fear of sex (B = 0.141, P = 0.036), positive cognition (B = 0.197, P = 0.046), self-image (B = 0.651, P = 0.001), sexual intimacy (B = -0.116, P = 0.021), quality of sexual life (B = 0.115, P = 0.002) and education (B = 2.129, P = 0.024) from the bio-psychosocial model were the final predictors of vaginismus diagnosis score in women with this disorder. According to the results of multiple linear regression, 45.5% of the variance of vaginismus diagnosis total score was explained by these variables (R = 0.706, R2 = 0.498 and ADJ.R2 = 0.455).

Conclusion

The results of the present study showed that the variables of fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education were the final predictors of vaginismus diagnosis score. This disorder is, thus, considered to be multidimensional.

As a sexual dysfunction, Vaginismus prevents sexual penetration through involuntary and frequent spasms of the muscles in the one-third of vagina's outer part. Factors such as negative beliefs about sex, cultural factors, fear of pain, injury, bleeding and so forth play significant roles in the prediction of vaginismus. Therefore, given the multidimensionality of vaginismus and the need to pay attention to all biological, psychological and social dimensions in treating it, and since the bio-psychosocial model is a strong framework for the factors contributing to sexual problems whose recognition will lead to the design of multidimensional treatments, the present study was conducted on 180 Iranian women with vaginismus to investigate the bio-psychological factors associated with vaginismus. The present study showed that the fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education from the bio-psychosocial model were the final predictors of vaginismus diagnosis score. Therefore, this model can be used in designing interventions for the treatment of vaginismus, especially in the psychological and interpersonal domains.

Psychological Predictors of Sexual Quality of Life Among Iranian Women With Vaginismus: A Cross-Sectional Study

Background

Vaginismus is an involuntary contraction of muscles around the vaginal and one of the most common sexual disorders among women. It is often associated with psychological problems, leading to poor sexual quality of life (SQOL). This study aimed to determine SQOL predictors in women with vaginismus.

Methods

In this cross-sectional study, convenience sampling was used to enroll 236 individuals with vaginismus among all women visiting sexual health clinics of Tehran, Iran in 2018. The data were collected using the Sexual Quality of Life-Female (SQOL-F) Questionnaire, Hospital Anxiety and Depression Scale (HADS), and Rosenberg Self-Esteem Scale. The data were analyzed using the General Linear Model (GLM).

Results

The mean (SD) SQOL score of the participants was 56.82 (20.18). There was a significant direct correlation between the participants' self-esteem and their SQOL (r = 0.54, p < 0.001). However, the participants' SQOL had significant inverse correlations with the variables of anxiety (r = - 0.48, p < 0.001) and depression (r = -0.47, p < 0.001). Based on the GLM results, the variables of anxiety, depression, self-esteem, and duration of disorder predicted SQOL, and explained 42.3% of the variance of SQOL in the participants.

Conclusion

The results indicated that psychological factors such as anxiety, depression, and self-esteem are predictors of SQOL in women with vaginismus.

Psychometric properties of vaginal penetration cognition questionnaire (VPCQ) in Iranian women with sexual pain disorders

Aim

The aim of this study was to investigate the psychometric properties of the Persian version of the Vaginal Penetration Cognition Questionnaire (VPCQ).

Design

Cross‐sectional study.

Methods

This research was conducted in two phases from June 2019 to February 2020. Phase I: The World Health Organization Protocol of forward–backward translation and an expert panel in order to determine face and content validity. Phase II: Survey development with 352 eligible women with sexual pain disorders, construct validity, internal consistency and construct reliability were evaluated.

Results

The exploratory factor analysis showed that the Persian version of VPCQ has three factors that explained 53.94% of the total variance. Confirmatory factor analysis also confirmed the fit of the three‐factor model. Convergent and divergent validity were confirmed for all factors. The average measure ICC was 0.99 (95% CI 0.98 to 0.99). The absolute reliability with estimated SEM of 2.67 and MDC% of 28% approved the reliability of the questionnaire.

The role of personal factors in quality of life among Iranian women with vaginismus: a path analysis

Background

The aim of this study was to provide a path model for assessing the direct and/or indirect effects of psychological/behavioral parameters on health-related quality of life among women with vaginismus.

Methods

A cross-sectional study was conducted on a sample of 236 women with vaginismus disorder attending to sex clinics in Tehran, Iran from April 2017 to March 2018. Data were collected using a demographic questionnaire, the marital satisfaction scale, the hospital anxiety and depression scale, the rosenberg self-esteem scale, the body image concern inventory, the short-form health survey (SF-12) and the female sexual quality of life questionnaire. In addition to descriptive statistical data, the fitness of the proposed model was investigated using path analysis.

Results

The results of path analysis demonstrated that the final model had a good fit to the data (Chi-Square/degrees of freedom (Normed Chi²) = 2.12, root mean square error of approximation = 0.069, goodness fit index = 0.99, both comparative fit index = 0.99 and Tucker–Lewis index = 0.96). In this model, anxiety and depression significantly predicted health-related quality of life as measured by the SF-12.

Conclusions

Anxiety and depression are important components in predicting health-related quality of life among those suffering from vaginismus.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01799-5.

Challenges and strategies to end child marriage

OBJECTIVES

Child marriage is one of the most important challenges of the current era that threatens women's health and violates human rights. The present study aimed to systematically review studies evaluating the challenges and strategies to overcome child marriage.

CONTENT

Medical databases (CINAHL, EMBASE, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science, ProQuest Nursing and Allied Health Source, and Social Science Research Network, as databases for English studies and IranMedex, Google Scholar, SID, Magiran, and Iran Doc as databases for Persian studies) were systematically searched from January 2010 to February 2020. To better identify appropriate studies, reference lists of relevant studies were searched. All potentially relevant abstracts and full-text were screened by two independent reviewers. Disagreements between two reviewers that could not be resolved were resolved via arbitration or consultation of a third author.

SUMMARY AND OUTLOOK

From 225 articles included in this review, 16 research articles met our inclusion criteria. Most of the articles were dedicated to negative health outcomes related to child marriage. Ten studies addressed the program of overcoming the Child marriage and six studies reported challenges of it. Although, many studies have shown the efficacy of strategies to decline Child marriage. On the basis of the available evidence, it seems there are a number of obstacles to end Child marriage. To delineate the most effective strategy to end Child marriage is required further research.

“Being a Woman” in the Shadow of Vaginismus: The Implications of Vaginismus for Women

Introduction:

Vaginismus includes some psychological conditions such as fear of pain and avoidance from penetration. There is little knowledge about the effects of vaginismus.

Objective:

The present study aims to present the bio-psychosocial consequences of vaginismus in women life.

Methods:

The method of the present study is a review, which is conducted on the available resources. All relevant studies were included to present effects of vaginismus on the women.

Results:

Women who have vaginismus have many problems with self-identity, psychological and reproductive lives. Most of the effects of vaginismus lead to another deep effect on women. Women with vaginismus mostly describe themselves negatively. This negative self-perception affects women’s self-esteem levels which cause psychiatric disorders. The psychiatric disorders have been associated with vaginismus as a reason and result. It is stated in the studies that the general anxiety and, penetration specific anxiety are related to vaginismus. This result reflects that women with vaginismus have more anxiety about penetration. Women with vaginismus encounter reproductive problems, who are more likely to encounter increased cesarean section and fertility problems, they are reluctant to seek health care services, especially due to fear of the gynaecological examination.

Conclusion:

Although vaginismus is a common problem, there is little information about the effects of vaginismus on women. Vaginismus causes psychiatric disorders and reproductive problems. The researchers should examine how women live with vaginismus. It is also suggested that psychotherapy techniques should include couples interventions and, researchers should examine psychological health of women deeply.

Couple Therapy and Vaginismus: A Single Case Approach

Although Vaginismus, or an involuntary contraction of the vaginal muscles, is one of the reasons sexual intercourse difficulty is relatively common in Iran, few studies have addressed it. This research is a single-case type (AB) design. Initially, a pretest was taken from all participants. The number of sessions was estimated between 4 and 6 sessions, and the duration of each session was 45-60 minutes. Couple therapy sessions were conducted by an individual with a PhD in sexual and reproductive health. An FSFI questionnaire was completed before counseling, just after counseling, and 4 weeks after the last counseling session. During each session, the therapist reviewed the homework assignments of the previous session regarding emotions, thoughts, and experiences, and at the end of each session, the therapist answered the couples' questions. We introduce and follow up on five casesof couples who suffer from Vaginismus. The mean age for females was 29.5, and for males it was 32. The mean length of marriage was more than 5 years. The FSFI score of participants improved from baseline (A) after intervention (B). The study would appear to show that this treatment format may be a cost effective intervention for couples presenting with Genito-pelvic pain/penetration disorder (Vaginismus).

Vaginismus and pregnancy: epidemiological profile and management difficulties

Background

Vaginismus affects up to 1% of the female population and often represents a physical manifestation of an underlying psychological problem. Our objective was to investigate the psychosomatic impact of vaginismus in pregnant women and evaluate the quality of their therapeutic care in Tunisia.

Methods

We included pregnant patients with vaginismus who presented at our obstetric emergency department between October 2016 and March 2017. All patients were interviewed by one expert psychiatrist and gynecologist using a standardized questionnaire. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety and depression levels. Patients were prospectively followed until their postpartum period and were interviewed by the same experts after delivery. Sixteen weeks after hospital discharge, we contacted all patients via phone. All the information was simultaneously recorded in written form.

Results

Twenty pregnant patients with vaginismus were included (85% primary, 15% secondary). Most women described a conservative family background (70%) in which they received little or no sexual education (60%). All women described a feeling of anxiety and anger immediately before sexual intercourse and 40% have never sought medical consultation regarding their vaginismus before. Only 50% reported regular follow-up visits during their pregnancy (without vaginal examination), whereas 25% reported irregular follow-up visits with subjectively bad experiences during attempts of vaginal examinations.

Conclusion

Pregnant women with vaginismus are at risk of non-follow-up during their pregnancy due to underlying feelings of shame and experienced lack of understanding by medical staff. Obstetricians should carefully and attentively approach pregnant women with vaginismus in order to ensure adequate medical care during pregnancy.

The relationship between spiritual health and health-promoting lifestyle among students

BACKGROUND

One of the components of a healthy life is attending to spiritual needs, which can reduce harmful behaviors. The aim of the present study was to evaluate the relationship between spiritual health (SH) and health-promoting lifestyle (HPL) among students of Guilan University of Medical Sciences.

MATERIALS AND METHODS

The present cross-sectional study was conducted on 360 nursing and midwifery students at Guilan University of Medical Sciences. The data were collected using a self-administered socio-demographic questionnaire, Health-Promoting Lifestyle Profile-II (HPLP-II) and the Spirituality Well-being Scale (SWBS). Data were analyzed using SPSS-21 using descriptive and inferential statistics.

RESULTS

The results of the present study showed that the mean and standard deviation of the students' HPLP-II scores as 84 ± 28 and the mean and standard deviation of SWBS scores was 90 ± 15. Also, there was a statistically significant relationship between HPLP-II scores and SWBS scores (r = 0.032).

CONCLUSION

The finding of this study showed that SH impacts on a HPL. It is recommended for policy-makers and health providers due to the positive role of SH in improving HPLs.

Effect of pregnancy on sexual function of couples

OBJECTIVE

Sexual function is an important part of each human being's personality and in the general couple relationship, with an obvious impact on quality of life and safe sexual performance during pregnancy is important for couples. The objective of this study was to assess effects of pregnancy on sexual function of couples.

MATERIALS

In a prospective cohort study 123 couples were enrolled in the study when women were first diagnosed to be pregnant. During their pre-natal visits, Sexual function of couples was evaluated using the Iranian Version Index of Erectile Function (IIEF) in men and Female Sexual Function Index (FSFI) in women in three trimesters. Statistical analysis was performed.

RESULTS

Indices of sexual function showed significant regressions over time during pregnancy. The greatness of the problem was highest during the third trimester. Female sexual arousal and sexual satisfaction domain scores had the major correlation to IIEF total score. On the other hand, male intercourse satisfaction domain score had the maximum correlation to FSFI total score. A strong correlation between male and female sexual function was observed.

CONCLUSION

Sexual function is a widespread problem during pregnancy among Iranian couples. Therefore, pregnant women and their husbands need counseling about healthy sexual function in pregnancy.