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Background: Unconsummated marriage (UCM) is a significant yet underreported sexual health problem in South Asia, with a limited number of studies revealing limited information. Objective: To synthesize available literature on UCM in South Asia, focusing on risk factors, management strategies, clinical outcomes, and research gaps. Methods: A narrative review was conducted using PubMed, Scopus, Google Scholar, BanglaJOL, NepJOL, and Google. Original peer-reviewed studies published in English reporting on UCM in eight South Asian countries were included. Data on sample characteristics, etiologies, therapeutic interventions, and outcomes were extracted and analyzed descriptively. Results: Seven studies from India, Bangladesh, Pakistan, and Sri Lanka were included, with sample sizes ranging from single cases to 769 couples. Genito-pelvic pain emerged as the most common factor, followed by erectile dysfunction, premature ejaculation, and psychosocial factors such as fear, anxiety, and depression. Management strategies included psychosexual counseling and cognitive-behavioral therapy. Delays in seeking medical care ranged from days to over two decades, reflecting cultural taboos, lack of knowledge about sexual health, and social stigma. Conclusions: UCM in South Asia is an under-researched issue reflected by the number and designs of studies. Prospective studies with large sample and cross-cultural comparisons are essential to develop evidence-based management and improve sexual health outcomes for couples in the region.