NON CONSUMMATION OF MARRIAGE PRESENTING AS ANEJACULATION
Mr. Arvind (name changed), 40 yrs old came with H/O inability to ejaculate for last 3 years. He got married 8 years back with a teacher. The girl was not interested to have sex because as she said “I am not mentally prepared as yet” the boy took it as a sign of tiredness due to marital chores so didn’t object but it continued as such. The girl kept on postponing sex (there was no extra marital involvement as revealed by the boy himself) on one pretext or the other. The boy tried to force himself 2-3 times, there was appropriate erection but no significant penetration could take place and boy ejaculated on the outside of vulva. The girl got herself transferred to other city and ultimately they took divorce by mutual consent. The occasional sexual activity of the boy was limited to masturbation with reasonable enjoyment.
After divorce, the boy was convinced that he was impotent and developed moderate depression. He still masturbated occasionally but his libido decreased. Since 2 years – he couldn’t ejaculate as well while masturbating.
He approached me when his family members were forcing him for remarriage.
He was non alcoholic, non smoker, normotensive,nondiabetic. His srum testosterone level was at lower side of normal range, penile perfusion index was normal, NPT showed 2 episodes of erection for 15 minutes in total and rigidity was normal.
We started him on psychotherapy, antidepressants, testosterone supplementation, penile rehabilitation programme and PDE-5 inhibitors. It had less than expected response so intrapenile inj and vibrator therapy with 5 mm lateral displacement was added. He started ejaculating after 2 sessions.
Discussion – In this case, the girl was having severe vaginismus so she was extremely scared to have penetrative sex. The worst part was that she was not aware of her problem or she didn’t want to accept that she had a problem. Such cases need desensitization, dilation, psychotherapy, sex education and medicines. If such cases come to us, we take about 3-4 weeks to treat such a problem and results are extremely good.