Unconsummated marriage: etiology and treatment of erectile dysfunction in newlywed men-a narrative review with a focus on China.

BACKGROUND AND OBJECTIVE: Unconsummated marriage-erectile dysfunction (ED) occurring during the newlywed period-is a globally significant concern that adversely affects sexual quality of life and marital stability. In China, this condition exhibits particularly high prevalence and distinct cultural specificity, warranting focused investigation. This review aims to systematically elucidate the multifactorial etiology of newlywed ED and to propose culturally tailored, comprehensive treatment strategies. METHODS: This study drew upon peer-reviewed literature indexed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data up to May 2026, concentrating on original research and systematic reviews addressing the etiology and treatment of newlywed ED. KEY CONTENT AND FINDINGS: The onset of newlywed ED is shaped by a complex interplay of multiple factors: sociocultural pressures (e.g., constraints of traditional Chinese concepts, lack of sex education and societal silence, misleading information on social media, and religious and cultural backgrounds); psychological factors (e.g., new marital anxiety, sexual performance stress, problems in marital relationship and interaction, cognitive distortions and psychological imbalance, and sexual psychological trauma or adverse sexual experiences); and physiological factors (e.g., vascular, endocrine, neurological, or anatomical structural elements). These factors form a vicious cycle in which psychological anxiety exacerbates physiological dysfunction, which in turn intensifies psychological distress. CONCLUSIONS: Newlywed sexual dysfunction is not merely a physiological deficit; rather, it represents a dynamic process arising from the interaction of sociocultural, psychological, and physiological factors, with psychological distress playing a central role that perpetuates a vicious cycle of performance anxiety and erectile failure. Consequently, a comprehensive and individualized treatment strategy-involving both partners and integrating psychoeducation, cognitive-behavioral intervention, enhancement of marital intimacy, and physiological therapy-is essential to restore sexual function and promote marital harmony. This review provides a theoretical and practical clinical framework for the effective management of newlywed sexual dysfunction across diverse cultural contexts.