“What is the lived experience of individuals in heterosexual relationships who have been unable to have penile-vaginal intercourse despite wanting to do so?’’

This is the question at the heart of a new qualitative study on unconsummated marriages.

Concerned with the stigma of the term “unconsummated marriages”, the authors begin with an argument for using the terms PVI (penile-vaginal intercourse) and non-PVI instead. They argue that “unconsummated marriages” assumes marriage and thus does not account for couples who are not married. They also hope the change in nomenclature removes the stigma that “a relationship which has not been consummated with penile-vaginal intercourse lacks validity.”

After a brief literature review, they point out:

“There are no known qualitative studies within Canada or the United States exploring the lived experiences of individuals in heterosexual relationships that have never been able to have PVI”.

 

Specifically, they asked: 

(1) What is the meaning of PVI, and (2) What is the impact of the inability to have PVI on the relationship and sex life of individuals in heterosexual relationships who have been unable to have PVI?

Summary

Sample

Researchers advertised through sex therapists and pelvic floor specialists to identify 17 individuals (12 female/5 male) who fit the inclusion criteria as follows:

unable to have PVI due to pain, erectile dysfunction, vaginismus, pelvic floor dysfunction, anxiety, or other such reasons, which might be termed a combination of physical and psychological reasons…

Fourteen (14) were married, and all individuals were between 21 and 47 years old. They were highly educated and lived in either the US or Canada. Ten (10) identified no religion, five Christian, two Jewish, and one stated Muslim.

The above charts identify the stated reason individuals gave for the non-PVI and whether the individual identified the cause as being in the female, male, or both in the relationship. (Of note is none of the females reported the cause being in the male or in both.)

Researchers interviewed participants using the hermeneutic phenomenological approach (described in the paper) to explore: What does sex mean to you? What counts as sex? How has the inability to have PVI impacted your relationship?

Results

Researchers identified six phases (Early Learning, First Attempts at Penetration, PVI Attempts, Life Without PVI, Looking for Support, and Attempting Treatment) in which three themes were present in all phases: Shame and Embarrassment, Invisibility, and Centrality of PVI. These phases and themes are explored in the primary researcher’s dissertation (1)Bairstow, A.M. (2017). Is the coital imperative really imperative? An exploratory study of the experience of individual in heterosexual relationships who have been unable to have penile-vaginal intercourse. (PhD Dissertation), Widener University, PA.

“In this article, we focus on one aspect of the phase Life without PVI in addressing the meaning of PVI for participants. Participants’ discussion of the meaning of PVI reflected all three overarching themes of Shame and Embarrassment, Invisibility, and Centrality of PVI.”

Notable points from the analysis:

  • Participants identified sex as equal to, or defined by PVI and many reported they struggled to develop a sex life without PVI.
  • Those who did report a satisfying sex life considered themselves to be having sex. While their current sex life was enjoyable, they believed PVI would add a more mutual intimate behavior. Some identified they were missing out on something without PVI.
  • Others who reported a satisfying sex life described changes in their view of the centrality of PVI.
  • “Language can be an important tool in challenging the meaning of PVI to heterosexual relationships.” Broadening the definition of “virgin” and “sex” was meaningful in addressing the core themes.

‘‘[p]ersonally, I’ve, I hate the word unconsummated because, you know, I consummate my relationship just fine, thank you, just not with that.’’

~study participant

  • The more closely PVI was identified as primary to sex, the more negative the impact of not having PVI was to the individual. Half of the participants identified the inability to experience PVI as negative including separation and consideration of divorce.
  • Seven reported a positive impact including “validation from the fact that her relationship was strong despite the inability to have PVI”.
  • For the minority that identified a significant negative impact on their sex life, the primacy of PVI was apparent. “However, the majority of the participants were able to reject the coital imperative to some degree, allowing them to have pleasurable sex lives.”
  • “Some of the participants described a positive impact on their sex life as a result of the inability to have PVI, due to increased creativity and skill development.”
  • Whether sexual satisfaction improved or degraded seemed to be directly related to the couples ability to decentralize PVI.
  • For those who kept PVI as central, dissatisfaction grew and some reported increased distance and avoidance of other physically intimate activities as a couple.

‘‘[W]e’ve had to expand our definition of sex. To encompass this, and I actually think that’s been really good. Like, I think even if we ever figure out intercourse, like, I don’t know, there’s a way in which I’ll be kind of grateful. Because. . .I mean, I have the most creative sex life of anybody I talk to about sex.

~study participant

The authors discussed the results in light of script theory (2)Simon, W., & Gagnon, J.H. (1986). Sexual scripts: permanence and change. Archives of Sexual Behavior, 15(2), 97–120. https://doi.org/10.1007/BF01542219 Medline:3718206

Review

Qualitative data has a valuable role in early research into how we experience and define concepts. While it can be difficult to keep the researchers voice separate from the interpretation, the voices of the participants are typically rich and loud, as they are in this study. Bairstow (et. al.) undertook a valuable research study for her dissertation and provides those of us who work closely with this population some great data and direction.

The authors point out that the sample (small, but appropriate for this methodology) was recruited from those seeking help in achieving PVI in their relationship and results may be very different for those who choose not to seek assistance. Further research may show additional differences in couples where the inability to achieve PVI is due to pelvic floor issues/vaginismus or ED.

So What? …

Bairstow, et. al., have provided one more valuable argument for the principle that language and communication is critical to sexual satisfaction.

Experientially, we start this in our offices.

“professionals can refrain from using the term sex as a synonym for PVI, and from privileging PVI above other sexual activities. Professionals can expand their language when talking about sex to include a broader range of sexual activities.”

~Bairstow, et. al.

This is not only important in “unconsummated marriages”, but in other marriages where PVI is not a viable option. If PVI=sex, then there are a host of couples who cannot have “sex”:

  • the female breast cancer survivor whose vagina has sealed shut due to Lichen Sclerosus,
  • the male prostate cancer survivor with permanent ED due to nerve damage,
  • the diabetic who for whom neuropathy has caused permanent ED,
  • the individual whose medication results in PVI not being possible (or practical),
  • etc.

The article also points out homosexual couples fit into this category as may other couples with atypical sexuality.

Those of us invited to help couples with their sexual relationship have a unique opportunity to help address the shame and embarrassment through our acceptance. We can help couples feel less invisible as we normalize this issue. We can also assist as we redefine “sex” and what it means to have a satisfying sex life.

Let us know your thoughts and how you use this study by adding a comment below.

Citation

Bairstow, A. M., Pillai-Friedman, S., Crane, B., & Milhausen, R. R. Holy Grail or nice option: The meaning of penile-vaginal Intercourse in “unconsummated” relationships. The Canadian Journal of Human Sexuality, 0(0), 1-9. doi:10.3138/cjhs.2018-0015

References   [ + ]

1. Bairstow, A.M. (2017). Is the coital imperative really imperative? An exploratory study of the experience of individual in heterosexual relationships who have been unable to have penile-vaginal intercourse. (PhD Dissertation), Widener University, PA.
2. Simon, W., & Gagnon, J.H. (1986). Sexual scripts: permanence and change. Archives of Sexual Behavior, 15(2), 97–120. https://doi.org/10.1007/BF01542219 Medline:3718206