Unconsummated marriage in the Arab Islamic world: Tunisian experience

Short-term intracavernous self-injection treatment of psychogenic erectile dysfunction secondary to sexual performance anxiety in unconsummated marriages

“…While we demonstrated that a brief course (1-2 self-injections) of ICI was sufficient in all patients to overcome the psychogenic barriers of sexual performance anxiety, other studies with similar populations reported up to 30% required 3 or 4 ICI treatments [ 11 , 14 ].…”

“…Societies in which couples have enough opportunity for premarital sex, rarely report on unconsummated marriage. In contrast, in traditional and conservative societies, premarital sex is strictly prohibited and is considered scandalous and an insult to the family honor [ 11 ], therefore, the majority of current publications on unconsummated marriage originate from Eastern or Middle Eastern countries as Iran [ 11 , 12 ], Turkey [ 13 ], Tunisia [ 14 ], and Egypt [ 15 , 16 ]. Indeed, in many of these reports, psychogenic ED was considered to be the major etiological factor of unconsummated marriage, secondary to performance anxiety.…”

“…Indeed, the reports of higher dosages of intracavernous vasoactive drugs used were of papaverine 20 mg titrated to 40 mg [ 13 ] or up to 60 mg papaverine [ 14 ] or a mean dose of 70 mg papaverine or combination therapy of 10 mg phentolamine with papaverine 40-mg [ 13 ] up to 120 mg[ 12 ]. Consequently, due to the higher dosages of intracavernous vasoactive agents used in these studies often high rates of side effects, as prolonged erection and priapism (49%) and pain (47%) were reported [ 11 , 12 , 16 ].…”

“…Although the gold standard, treatment of psychogenic ED in sex therapy, is often a long, expensive process, which may result in treatment failure, often due to social and interpersonal factors, as the lack of the couples’ acceptance and compliance [ 5 ]. Consequently, very few studies in the literature, among a similar population, reported on compliance with sessions of sex therapy, resulting in various degrees of successful outcomes: from success of concomitant sex therapy with PDE5 inhibitors [ 13 ], to partial success in only 10 of 57 couples [ 14 ], while others reported all patients began ICI therapy following failed sex therapy [ 15 ].…”