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When the train never leaves the station

Suppose you married in June, all blushing with wedding night anticipation, but now find yourself in August still waiting for the train to enter the tunnel? Do unconsummated marriages still happen? Yes, more often than you think.
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Suppose you were married in June, all blushing with wedding night anticipation, but now find yourself in August still waiting for the train to enter the tunnel or the Apollo rocket to shoot into space.

Is such a thing possible? Do unconsummated marriages still happen in this age of 24/7 porn, reality show fraternization, and sex columns from respected news organizations?

They do — more often than you might think. Dr. Domeena Renshaw, a psychiatry professor at Loyola University Health System outside of Chicago, has treated hundreds of unconsummated unions.

“I would have thought it would have vanished by now,” she says, “but [we're currently treating] two couples.”

Nobody knows how many relationships — married or not — have yet to include intercourse despite both partners wishing they could get the party started. Educated guesses hover around 1 percent. Over the course of the 36 years she’s been in the business, Renshaw has treated 202 couples. Another expert, Talli Rosenbaum, a private practice physical therapist in Israel who works with couples in unconsummated relationships, says she has treated “a couple hundred” over the past 15 years.

The stand-off can be the result of physical problems, poor knowledge about sexual functions, religious conservatism, or other complicated emotional reasons, they say. Anxiety — no mystery why — often builds, so much so that couples can go years without ever having intercourse.

Sometimes even the 79-year-old Renshaw, who has pretty much seen it all, is surprised by how long the train remains in the station. One couple she treated had been married 23 years without consummating. The wife was a 44-year-old teacher; her husband a 47-year-old engineer. They had been to 13 different doctors before coming to Renshaw's tiny sex therapy clinic, which she founded in 1972 as part of Loyola's health center and still runs.

When Renshaw asked the couple why they had finally come to her, "she looked at me and tears ran down her cheeks," Renshaw remembers. "She said, ‘we did not know there was a place.’”

'Derision and sarcasm'
Too often, Renshaw says, couples can suffer so long without getting proper help due to the dismissive attitude of medical professionals. In a 1956 article in the British Medical Journal, a psychiatrist named Hilda C. Abraham wrote, “many patients might find help much sooner if their first attempts were not so often met with lack of understanding and impatience, if not derision and sarcasm.”

More than 50 years later, it still isn't uncommon for doctors to tell women to "just have a glass of wine and relax.” But alcohol and Barry White songs aren't always the solution.

The female half of Renshaw’s couple who had been married 23 years, for example, suffered from extreme vaginismus, an involuntary clamping down of the muscles so the vagina is sealed tighter than the White House Situation Room. Renshaw treated them through a combination of counseling and gradually coaching the woman on how to insert first her own finger, then her husband’s finger, then his penis. “By week four of the seven-week treatment, they had come to the point they had intercourse,” Renshaw recalls.

Other women suffer from vulvodynia, an often unbearable pain when the genitals are touched. Men can have erectile dysfunction.

These possible organic causes are why most therapeutic sessions start with a thorough physical exam, followed by counseling and confidence boosting.

Rosenbaum sometimes prescribes pelvic floor exercises for women, along with the use of plastic “dilators” of increasing thickness. Of course, men can be prescribed ED drugs, too.

Taking the pressure off
Often, however, unconsummated marriage isn’t really due to the workings of the penis or vagina. For example, medical reports show such marriages are more common in countries with strict religious cultures. A clinic in Istanbul reported treating 404 unconsummated marriages in just four years. An Iranian hospital evaluated 200 cases in two years.

For some men in these cultures, the wedding night is something like being thrown in to pitch for the Chicago Cubs with the score tied in the bottom of the ninth and the bases loaded. “The main factor associated with an unconsummated marriage was the intense social pressure to accomplish hasty coitus with an unfamiliar woman (some men having had no social contact with their new bride), and in the presence of relatives waiting nearby for evidence of the bride’s virginity and confirmation of coitus,” one Iranian doctor reports.

That sort of pressure could wilt any guy.

Women raised to place most of their self-esteem and identity in virginity can have a tough time “taking on a new role as a married woman and a new identity as a sexual human being,” Rosenbaum, who often treats Orthodox and ultra-Orthodox Jews, says. Their nervousness and anxiety can create vaginismus.

“Educating a couple to take their time, experience sexuality and intimacy rather than view it as a performance or a test, or as a task you either pass or fail, often takes the pressure off,” Rosenbaum says.

Treatment does not always work if the circumstances are complex. According to Rosenbaum, “sometimes, even after the education has been provided, the anxiety reduced, and the sexual dysfunction has been treated, we find that the couple still does not have intercourse” if, say, one member of the couple is blaming another. Sometimes “outside intervention — community, parents, religious leaders — can perpetuate this condition.”

The good news is that treatment usually works. Renshaw, for example, boasts an 80 percent success rate at the low, low price of just $1,400. The relatively cheap cost is one reason so few doctors venture into the area, but both Rosenbaum and Renshaw say the happiness payload is worth the effort.