Those Wedding Night Blues

From the WebMD Archives

June 1, 2001 -- It is the season of rings and rice. This month, thousands of couples will say their vows and become husband and wife. But what happens if after saying "I do," the groom just can't? A condition known as honeymoon impotence may be to blame, and it is more common than you think.

Actually, most western newlyweds have little to fear, because their first sexual encounter is probably but a distant memory when they walk down the aisle. But honeymoon impotence is apparently common among males who are virgins when they marry, and a new study suggests it isn't all in their heads.

Researchers in Turkey, where religious and cultural mores discourage sex before marriage, have thrown cold water on the belief that honeymoon impotence is almost always caused by performance anxiety. They found that for approximately one in four of the men in their study there was a physical reason for their failure to perform. The findings were published in the April issue of the journal Urology.

"It is true that 98% of the people in Turkey are Moslem, and sexual intercourse before marriage is forbidden in Islam," study author Mustafa Faruk Usta, MD, of Istanbul University, tells WebMD. "In Turkey, virginity until marriage is still a matter of honor on the part of the bride and groom. Most couples expect to have their first sexual experience on their wedding night, and obviously this can cause heavy psychological stress on both parties."

Because little research has been done on the phenomenon, stress has been blamed for first-time failures. But when researchers studied 90 patients who sought help for impotence during the first months and even years of marriage, Usta and colleagues found that almost 28% had penile blood flow problems that prevented erections.

Many of the patients in the study, who ranged in age from 18 to 39, waited more than a year after marriage to seek a physical cause for their impotence. Usta says some of these men first sought psychiatric counseling for the problem while others were too embarrassed to seek treatment at all.

Impotence expert William Steers, MD, who chairs the department of urology at the University of Virginia Health System in Charlottesville, has another view of honeymoon impotence. He says erectile dysfunction at first sexual encounter is not uncommon in this country, and the cause is usually psychological.

"I work in a university town, and we do see a significant number of students who are seeking medical attention for this problem," Steers tells WebMD. "The vast majority of the time it is due to performance anxiety."

He says depression is a major cause of sexual dysfunction among younger males, but fear of AIDS and other sexually transmitted diseases is also a common culprit. Inexperienced males may also have performance problems if they believe their partner has much more experience.

"I have guys in their 20s walk in the door who are convinced there is something physically wrong with them, even though the tests don't show this," he says. "Nobody wants to hear that the problem is psychogenic, and if you tell them this they will run, not walk, to another physician to find out what is 'really' wrong."

Steers says tests measuring penile blood flow are notorious for producing false positives. For this reason, the findings of Usta and colleagues may exaggerate the physical origin of impotence problems in the young males included in the study.

"The thing is, unless someone has very severe [psychological] problems or a serious medical condition, the range of therapies you offer are pretty similar no matter what the origin of the problem," he says. "But you have to do a reasonable workup to rule out these dangerous problems."