Erectile Dysfunction (ED) is one of the most misunderstood yet common challenges faced by men, particularly in South Asian and conservative Muslim societies. While most assume it to be a purely physical condition, the truth is that a large portion of ED cases are psychogenic—originating from emotional and psychological factors such as anxiety, guilt, or fear.
A groundbreaking research paper by Dr. Farooq Nasim Bhatti, Pakistan’s first recognized medical sexologist and head of Nasim Fertility Center (NFC), has shed new light on this issue.
The paper, titled “Psychogenic Erectile Dysfunction in Non-Consummated Marriages That Are Non-Responsive to PDE5 Inhibitors, Are to Be Treated by IC Drugs, Pharmacotherapy, and Psychotherapy,” was presented at the 22nd Congress of the World Association for Sexual Health (WAS) held in Singapore, 2015.
The findings of this research have global implications—challenging traditional treatment models for ED and providing new hope for couples struggling with non-consummated marriages.
Understanding Non-Consummated Marriages and Psychogenic ED
A non-consummated marriage refers to a marital relationship in which sexual intercourse has not yet occurred, even after marriage. This can happen for various reasons—medical, psychological, or relational—but in Dr. Bhatti’s extensive experience, psychological causes are the most dominant.
Psychogenic ED occurs when emotional factors like performance anxiety, fear of failure, guilt, or relationship tension prevent the man from achieving or maintaining an erection. The body’s stress response triggers the sympathetic nervous system, causing physical symptoms such as trembling, rapid heartbeat, sweating, and a dry mouth—all of which make arousal nearly impossible.
In cultures where sexual experience before marriage is rare and discussions about intimacy are taboo, newly married men often face extreme anxiety during their first sexual encounters. This anxiety can spiral into persistent fear, creating a cycle of anticipatory anxiety—the more one worries about failure, the more likely failure becomes.
The Research at Nasim Fertility Center
Between 1995 and 2013, Nasim Fertility Center in Lahore and Islamabad treated 4,250 patients suffering from non-consummated marriages. The research covered men between the ages of 20 and 50, with 85% under 35 years old—highlighting that this problem primarily affects young newlyweds.
Key Observations
The duration of marriage among patients ranged from a few weeks to 17 years, showing that many couples silently struggle with unconsummated relationships for years.
94% of the cases were purely psychogenic, without any organic or hormonal dysfunction.
Most patients showed signs of high sympathetic activity—rapid pulse, sweating, trembling, and muscle tension during attempts at intercourse.
88% of the men had already used PDE5 inhibitors (like sildenafil) on their own or through general practitioners, urologists, or traditional healers.
However, 68% reported no erection at all, while 32% achieved partial erection or premature ejaculation before penetration.
These statistics revealed a critical truth: standard ED medications were ineffective because the root cause was not physical.
Why PDE5 Inhibitors Fail in Psychogenic ED
PDE5 inhibitors (such as Viagra or Cialis) are effective in treating organic ED, where the issue lies in poor blood flow or nerve damage. However, they have limited to no impact when the problem is psychological.
In psychogenic ED, the brain blocks arousal due to anxiety or fear, overriding the medication’s physiological effects. Even if the blood vessels respond to the drug, the stress-induced adrenaline surge counteracts it, preventing an erection.
Dr. Bhatti’s research identified this as the key reason for the global mismanagement of ED—many patients are prescribed medication without addressing the mental and emotional components of their condition. The result is frustration, loss of confidence, and worsening anxiety.
The Treatment Approach: Combining Science, Therapy, and Compassion
To address this complex condition, Dr. Farooq Nasim Bhatti developed a comprehensive treatment model integrating intracavernosal (IC) injections, pharmacotherapy, and psychotherapy.
1. Psychotherapy and Sex Counseling
Each patient and, when possible, their partner underwent sessions focused on reducing anxiety and rebuilding communication.
Patients were educated about normal sexual physiology and reassured that their condition was treatable.
Counseling emphasized relaxation techniques and communication exercises to increase emotional closeness.
Partners were encouraged to shift focus away from performance and toward affection and comfort.
2. Pharmacotherapy
For men with severe anxiety or depressive symptoms, low-dose SSRIs (Selective Serotonin Reuptake Inhibitors) and benzodiazepines were used for short-term relief. These helped reduce fear and promote calm during intimacy.
In some cases, sex hormones were administered for two weeks to enhance libido and confidence.
3. Intracavernosal (IC) Drugs and Home Exercises
For patients who failed to respond to oral medication, IC injections were introduced under supervision. These injections directly stimulate an erection by improving penile blood flow and relaxing smooth muscles—bypassing the brain’s psychological barrier.
At home, couples were advised to perform graded intimacy exercises—starting with non-penetrative affection and gradually progressing toward intercourse as confidence increased.
4. Duration and Success Rate
The treatment plan typically lasted 10 weeks, during which patients regained normal sexual function in stages.
95% of couples achieved successful intercourse through therapy and counseling alone.
The remaining 5%, who had severe injection phobia, were successfully treated with a combination of PDE5 inhibitors and vacuum constriction devices.
By the end of the program, the study reported a 100% success rate in consummating marriages.
Key Findings from the Study
PDE5 inhibitors are not the solution for psychogenic ED.
The study confirmed that these drugs fail when performance anxiety and psychological stress dominate.Performance anxiety activates the sympathetic nervous system.
The resulting physical symptoms—sweating, trembling, and increased heart rate—prevent sexual arousal.Combination therapy works best.
Psychotherapy, pharmacological support, and targeted IC drug use create a multi-layered approach addressing both the mind and body.Marital intimacy improves beyond sexual function.
Counseling enhances trust, communication, and understanding between partners, strengthening the emotional foundation of marriage.
Implications for Patients and Healthcare
Dr. Farooq Nasim Bhatti’s research highlights a major clinical and cultural insight: psychogenic ED requires emotional healing, not just physical treatment. In societies where men feel pressured to “perform” perfectly on the wedding night, anxiety often leads to repeated failure and deep shame. Without intervention, the cycle can last years and destroy relationships.
This study offers hope. It shows that with structured counseling, supportive partners, and evidence-based therapy, even long-standing non-consummated marriages can be successfully resolved.
A Milestone for Sexual Medicine in Pakistan
By presenting this research at the World Association for Sexual Health Congress in Singapore (2015), Dr. Bhatti positioned Nasim Fertility Center among global leaders in sexual-medicine innovation.
His findings demonstrate that sexual dysfunction is not only a medical issue—it is a human issue that demands empathy, education, and multidisciplinary care.
Today, NFC continues to apply this integrated model in Pakistan, helping thousands of men and couples overcome psychogenic ED and infertility with privacy, compassion, and scientific accuracy.
Conclusion
The study concludes that psychogenic erectile dysfunction in non-consummated marriages cannot be effectively treated with standard ED pills alone. The key lies in addressing the psychological roots—performance anxiety, guilt, and fear—through psychotherapy and sex counseling, supported by pharmacotherapy and IC drugs when necessary.
Dr. Farooq Nasim Bhatti’s research proves that when couples receive the right guidance, understanding, and clinical care, even the most challenging cases of non-consummated marriage can achieve complete recovery.
If you or your partner are struggling with intimacy or an unconsummated marriage, confidential help is available.
📍 Visit Nasim Fertility Center in Lahore, Islamabad, or Faisalabad.
📞 0300-4577606 📧 nasimfertilitycenter@hotmail.com
Your privacy is protected, and your healing begins with understanding—not judgment.
Reference
Muhammad Amir Farooq Nasim. Psychogenic Erectile Dysfunction in Non-Consummated Marriages That Are Non-Responsive to PDE5 Inhibitors, Are to Be Treated by IC Drugs, Pharmacotherapy, and Psychotherapy.
Presented by Dr. Farooq Nasim Bhatti at the 22nd Congress of the World Association for Sexual Health, Singapore (2015).
Dr. Farooq Nasim Bhatti (MBBS, FAACS – USA, Diplomate: American Board of Sexology, CST, HSC – Hong Kong, CART – Malaysia & China) is a qualified medical sexologist with 30+ years of experience. He has presented 21+ research papers internationally and treats sexual dysfunction through sex therapy, counseling, and pharmacotherapy to restore natural sexual function without temporary medication.
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