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Before The First Night

Last updated: 16 September 2008, Tuesday

Author: Silvan S. Prayogo, BSc., MSc.


Investigations by a group of American psychologists concluded that the main reason for a high rate of divorce is likely due to lack of openness before marriage. In a married couple, bad things that were neatly hidden before marriage may cause someone to feel "cheated" by the other and  lead to a serious conflict.


Therefore, this group of American psychologists recommends that an engaged couple should openly and honestly discuss all matters, good and bad, before marriage. This discussion should help them anticipate any problems that may arise if they choose to get married or cancel their engagement to avoid a divorce later on.


These psychologists recommend that a pre-wed couple should once in awhile initiate conflicts or arguments in their relationship to learn each other's "true nature".


So, what should be a good topic for an argument? One of the good topics is premarital medical check up. Premarital health issue is very sensitive for a couple because it affects many aspects of life that when honestly revealed may end their relationship.


A premarital medical check up discussion involves an openness, honesty, responsibility to one and another and to a child (children) who is going to be raised, family secrets (hereditary diseases), financial burden due to health problems (expensive medical costs), risky hobbies or habits before marriage (free sex and illegal drug use/addiction), and  behaviors or characters that are accidentally unleashed during a discussion (selfish, sensitive, naive, rude, and so on).


The discussion may influence a couple to reconsider their marriage plan because premarital medical tests would potentially reveal each other's secrets. If someone refuses to do the test, then he or she is likely to have serious secrets that may potentially cancel their marriage.


The impending threat of HIV/AIDS does not only end a marriage. It may also threaten the life of your spouse and the unborn child. A premarital medical check up may consists of:

  1. General tests such as Ultrasonography (USG), X-ray, laboratory tests, and many more.

  2. Sexually Transmitted Diseases (STDs) tests.

  3. Pre-pregnancy tests (TORCH, etc).

  4. Fertility tests.

  5. Genetic test.

The above tests surely cost a lot of money. However, the cost of these tests is nothing compared to the cost of a gorgeous wedding party, exclusive pre-wedding photography, and many more. Moreover, a couple may select which tests are rendered necessary, thus, more cost efficient.


The test results should help a couple to imagine the implications of any diagnosed disease if they decide to continue their relationship. Test results may unmask each other's true-self that were hidden during courtship.


There are several cases of married couples who are disappointed because they did not do a premarital medical check up:

  1. Test results of a pregnant wife indicated STD infections. Who is to blame? Is it her husband? Does he still continue his bad habit? Does he even realize the serious threat on the life of his wife and unborn child?

  2. A wife who is disappointed at her first night with her husband because the man has been a diabetic for a long time and impotent.

Premarital medical tests on a pre-wed couple may consist of a general check up such as laboratory tests or urine test to examine organ functions. Additional tests such as an X-ray photo of lungs, Electrocardiography for heart, USG, and others may be added if necessary.


Chromosome analysis or genetic counseling by a geneticist may indicate any possibility of passing down a hereditary disease.


Fertility test can be done with sperm analysis, hormonal tests, and others.


Last but not least, medical tests for infectious diseases such as TORCH (Toxoplasmosis, Rubella, CMV, and Herpes Simplex Virus), HIV, Hepatitis B Virus (HBV), Herpes Simplex Virus Type 2, and Syphilis.



It is caused by a single-celled microorganism (protozoan) known as Toxoplasma gondii. Approximately 80-90% of Toxoplasma infection is asymptomatic. Signs of infection may look like a common cold such as fever and sore throat. Women who expect to get pregnant should watch out for Toxoplasmosis because infection to a fetus may result in an abortion or congenital defects such as blindness.


Studies have shown that Toxoplasma usually resides in pets particularly cats. Infection to human occurs when he/she touches its stool or soil where the stool was. Risk of infection is significantly higher when you consume raw meat or undercooked meat. Infection can be avoided by maintaining your pets' hygiene and health, wear a pair of gloves when cleaning animal stool, properly wash your hands after touching a soil, and avoid raw or undercooked meat. Pregnant women should be kept away from pets stool. An infection to a fetus can be prevented if toxoplasmosis is detected and treated before pregnancy.



Rubella or German measles is a viral infection that usually attacks children. Rubella infection usually harmless and the virus will disappear on its own. An infected person can be asymptomatic. Immunity from Rubella is obtained after recovery from its infection. Symptoms of Rubella, if any, may be similar to common cold such as cough, runny nose, sore throat, headache, fatigue, and fever. Symptoms may also appear as skin rash all over your body. This rash usually disappears within a week. Sleep and fever medicines usually good enough to cure Rubella infection.


Rubella is an airborne infection (e.g. coughing). Although Rubella is considered harmless, Rubella virus is fatal for a fetus. A Rubella-infected pregnant woman may pass on the virus to her unborn baby and results in Congenital Rubella Syndrome (CRS).


A CRS may include heart abnormality, poor vision and hearing, or premature birth. Therefore, a Rubella test is necessary for women before pregnancy. Based on Rubella test result, a medical doctor could recommend a Rubella vaccination and to postpone pregnancy for approximately three months after vaccination to prevent Rubella infection during pregnancy.


Hepatitis B Virus (HBV)

HBV attacks a liver and may cause cirrhosis, cancer, organ failure, and death. Symptoms of HBV infection are jaundice, stomachache, loss appetite, nausea, and painful joints. Risk factors include free sex, sharing needles for illegal drug intravenous injection, hemodialysis, or from an infected mother to her unborn baby. Pregnant women who do not know that they are infected have 90% chance to infect their unborn child.


HBV infection can be avoided by Hepatitis B vaccination, avoid free sex, keep away from illegal drugs or tattoo, avoid sharing personal tools that may have come in contact with blood such as shaving blades or tooth brush.


HBV infection in a pregnant woman is detected by blood-based HBsAg test. If  she is found positive for HBV infection, she must be given Hepatitis B Immuno Globulins (HBIG) and her baby must receive an injection of Hepatitis B vaccine within 12 hours after delivery.


Genital Herpes Simplex Virus (HSV type 2)

HSV type 2 infection is a Sexually Transmitted Disease (STD) that has an incubation period of approximately seven days after sexual intercourse. HSV type 2 infection occurs through a direct contact with saliva, genital fluid, or wounds of a person infected with the virus.


Sign of HSV type 2 infection is skin lesions around genitalia that will disappear in three weeks and reappear at another time (recurrence). HSV 2 can be passed on from an infected mother to her baby during delivery. HSV 2 infection may cause death or mental retardation to her baby. Risk of HSV 2 infection to an unborn baby increases if there is a lesion near the mother's vagina. There is no cure for HSV 2. However, Acyclovir is usually administered to suppress viral expansion, prevent recurrence, and minimize contagions.



Syphilis is one of STDs that is caused by bacteria, Treponema pallidum. These bacteria are sensitive to lights, air, and temperature changes. Therefore, sharing a toilet seat, bathroom, clothing, or kitchen utensils with someone that has syphilis are unlikely to cause an infection. By contrast, syphilis infection occurs by kissing, direct contact with a lesion of an infected person, blood transfusion, or from an infected mother to her unborn baby through blood flow into her placenta.


Syphilis lesions may be hidden in a vagina or rectum. Therefore, a syphilis-infected person may show no visible signs of infection. Unfortunately, a syphilis-related lesion ease HIV infection. As a matter of fact, HIV can be found in a syphilis-infected person and vise versa.


Syphilis infection consists of four stages. The first stage infection (primary syphilis) usually appears as a chancre within 10 weeks to three months after infection. The chancre usually marks the point of viral entry on the body of an infected person. The chancre can be found around genitalia, anus, tongue, or lips. Signs of primary syphilis usually disappear without any medication. However, without an immediate medication, the bacteria remain and progress into the second stage infection (secondary syphilis).


Secondary syphilis usually occurs two to ten weeks after chancres appeared. Signs of secondary syphilis are fever, tiredness, and the appearance of a coin-sized reddish or brownish rashes in some parts of the body including the palm of hands and sole of feet. These signs may continuously appear and disappear for a year.


Untreated secondary syphilis enters a latent stage, which shows no signs at all until it enters the last stage of infection (tertiary syphilis). Tertiary syphilis is lethal because it causes brain inflammation, paralysis, vision and hearing problems, heart problems, and death. Signs of tertiary syphilis may appear years after the first infection.


Syphilis infection from a mother to her unborn child may result in an abortion, vision or hearing problems, congenital bone and teeth defects. Therefore, an early detection of syphilis in a pre-wed couple is important especially because syphilis is easy to cure as long as the infection is in early stages. Syphilis is cured with an antibiotic, penicillin. However, please remember that recovery from syphilis infection does not make you immune against the bacteria. Risk of re-infection remains especially if free sex habit continues.



Based on the above information, diseases or disorders that are detected earlier in a couple provide an opportunity to anticipate a long term burden that they must endure. For instance, by postponing their marriage until the disease is completely healed or "tamed". A child's life can be badly affected by couples who neglect health risks.

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