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Treatment for couples presenting with sexual difficulties should consider the context of the couple's lives and their cultural milieu. Practitioners treating couples from traditional and faith-based societies should acknowledge, respect, and be willing to modify treatment to conform to the clients' beliefs. The purpose of this article is to describe the case of a young ultra-Orthodox couple presenting with unconsummated marriage and to illustrate and elucidate the multidisciplinary and culturally sensitive treatment provided.

Objective: The authors examined instances of past sexual abuse and related demographic characteristics in the self-reports of a select group of married observant Jewish women., Methods: Orthodox Jewish married women (N=380) ages 19 to 58 responded to advertisements asking them to complete an anonymous questionnaire about sexual experiences, including sexual abuse., Results: Sexual abuse was reported by 26% of the respondents surveyed, with 16% reporting abuse occurring by the age of 13. More ultra-Orthodox Jews reported abuse than modern-Orthodox Jews. Women who were raised observant reported significantly less childhood sexual abuse than those who became observant later in life. Sexual abuse was associated with increased treatment-seeking for depression, marital counseling, or other emotional or psychological problems., Conclusion: While observant Jewish women live in a culture defined by a high degree of adherence to specific laws of conduct, including rules designed to regulate sexual contact, sexual abuse of various types still exists among them.

Orthodox Judaism expects new brides and grooms to engage in sexual intercourse on the first night of marriage or soon thereafter, despite stringent norms forbidding premarital physical contact. Any delay for more than several weeks in consummating a marriage is seen as problematic and worthy of rabbinic or professional attention. This article examines traditional Jewish sources for this emphasis on marital sexuality, defines the problem of unconsummated marriages, discusses issues pertinent to evaluation, and suggests appropriate treatment strategies. Our focus includes both the Orthodox and Ultra-Orthodox (Haredi) elements of the Jewish community.