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Introduction: Little research has been conducted about unconsummated marriage (UCM)., Aim: To report the long-term outcome of male sexual dysfunction (MSD) in UCM., Methods: From 1997 to 2008, 417 couples presented to the author with UCM. The mean UCM duration ranged from 1 hour to 8 years. The median follow-up was 78.5 months., Main Outcome Measures: Self-reported MSD in UCM based upon clinical history taking., Results: In 177 cases, UCM was due to erectile dysfunction (ED) (86), premature ejaculation (PE) (89), performance anxiety (25), vaginismus (34), hypodesire disorder (6), not knowing the coital technique (8), men who have sex with men (MSM) (2), hypogonadism (1), request by bride to delay coitus (1), and thick hymen (1) (more than one factor involved in many cases). In the remaining 240 cases, UCM was due to being under social pressure to have a quick intercourse while relatives waited behind the door to confirm and celebrate coitus by checking a handkerchief that was placed beneath the bride to become bloody by hymen perforation. Intracavernosal injection (ICI) using papaverine +/- phentholamine was used in 239 cases (57.3%); 221 (92.4%) responded. The eight cases who did not know the coital technique responded to sex education. Of the 50 men who were prescribed phosphodiesterase type 5 inhibitors, only 4 responded. Of the 26 men who received clomipramine (21) or fluoxetine (5) for PE, 2 and 1 responded, respectively. Fourteen grooms who did not respond to treatments later consummated spontaneously. No treatment was given to 94 grooms, including men with a diagnosis of psychotic disorder, men with learning difficulties, divorcing patients, and men in obligatory, loveless marriages. Ten untreated patients later consummated spontaneously. Of the 260 patients who consummated either with treatment (236) or spontaneously (24), 58 (22.3%) later presented with sexual complaints. The remaining 202 did well at a follow-up. Of the 157 couples who did not respond to treatment or did not receive treatment, 62 were either divorced or divorcing., Conclusion: We strongly advise ICI as the first-line treatment of UCM. Oral therapies of ED and PE, vacuum constriction devices (VCD), and hymenectomy are of limited value. No treatment is indicated in many cases. Most grooms do well sexually in a long-term follow-up.