背景:未完成婚姻(UCM)是异性恋已婚夫妇无法进行阴道性交。
目的:本研究旨在系统回顾目前关于UCM病因和临床治疗的证据。
方法:在MEDLINE上进行全面的书目搜索,Scopus,WebofScience,Cochrane图书馆数据库于2023年6月进行。如果他们在病例报告或病例系列中描述了从未发生过性交的已婚夫妇,则选择研究以定性评估相关原因和/或管理和报告数据,定量,或混合方法。根据PRISMA(系统评价和荟萃分析的首选报告项目)声明报告,并在PROSPERO中注册,ID为CRD42023433040。
结果:共27项研究,包括1638名男性和1587名女性。8篇(29.6%)文章是涉及一对夫妇的病例报告,19篇(70.4%)研究是病例系列。平均Murad评分为4.1(范围,1-8)显示低中间的整体研究质量。所有文章的证据水平均为4。大多数研究在埃及进行(n=5[18.4%]),以色列(n=4[14.9%]),和美国(n=4[14.9%])。男性和女性的平均年龄在24.2至37.6岁和21至27.4岁之间变化,分别。导致UCM诊断的医疗访问的原因是在23项(85.2%)研究中无法完善,无法在一篇(3.7%)文章中怀孕,并混合在3(11.1%)个物品中。UCM的平均持续时间从7天到3.5年不等。涉及男性和女性的八项研究表明,阴道痉挛(8.4%-81%)和勃起功能障碍(10.5%-61%)是UCM的最常见原因。三篇文章报道,所有UCM病例中有16.6%至26%是由于男性和女性因素造成的。西地那非,他达拉非,海绵体内注射,阴茎折叠术,女性生殖器重建手术,阴道扩张器,润滑剂性心理治疗,在27项研究中,性教育是各种治疗方式,完成率为66.6%至100%。
■一个优点是,这是第一个涵盖UCM整个范围的系统综述。局限性包括大多数纳入的文章的质量低,以及可能未发表的大部分UCM案例。
结论:勃起功能障碍和阴道痉挛是UCM报道最多的原因;然而,强大的心理因素无疑是许多案件的基础。基于性教育战略整合的多学科方法,医学治疗,性心理支持,手术治疗似乎是管理UCM夫妇的最合适选择。
BACKGROUND: Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse.
OBJECTIVE: 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%.
UNASSIGNED: 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.
CONCLUSIONS: 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.