PRENUPTIAL EXAMS: WHAT THEY ARE AND WHAT THEY DETECT - MEDICINE - 2025

The prenuptial exams or prenuptial analysis are a series of tests that a couple performs, on a mandatory or voluntary basis, prior to marriage. They include physical and mental evaluation, laboratory tests and even genetic tests. The objective is to know the health status of each member before the decision to form a family.

The existence of infectious-contagious diseases is one of the main justifications for requesting prenuptial exams. In addition, it is necessary to know both the blood type and the chronic, degenerative and hereditary diseases of the man and the woman before marrying. The state of mental health of each should also be reviewed.

In some countries - Spain, Mexico, Brazil, Peru, Argentina, among others - there are laws that require pre-nuptial examinations as a prerequisite to marriage. In North America, some states require couples to screen for communicable diseases and promote family medical history review before marriage.

Eugenics - a term proposed by Francis Galton in 1883 - historically served as an excuse to justify the evaluation of premarital health. The approach suggests maintaining the genetic quality of the human being, avoiding anything that could affect or degenerate it.

The purpose of marriage is to form a family and procreate. It is a valid argument to explain the concern that arises about the health of future spouses.

Mandatory or voluntary, conducting prenuptial examinations is the tool to know the physical and mental state of a couple when they decide to marry.

What does it consist on?

They are tests and exams that are carried out before marriage and married life. The prenuptial exams show the physical and mental fitness of the couple before they get together and have children. The exams required before marriage will depend on the legal requirements or the decision of each couple.

Most laws require the detection of communicable diseases - HIV, syphilis or hepatitis B - as well as blood compatibility tests. It is important to have complete clinical evaluations, including psychological evaluation.

Genetic testing is often expensive. It is not a legal requirement as a requirement, despite the eugenic argument that supports them.

Genetic testing is intended for specific cases of inherited diseases; the consanguinity relationship between the man and the woman are criteria for this type of study.

A detailed evaluation involves a long list of tests and evaluations that, in most cases, are not required. Premarital exams can be:

- Physical evaluation.

- Mental or psychological examination.

- Laboratory tests, including screening for communicable diseases.

- Genetic profile.

What do they detect?

As important as the performance of prenuptial exams is the interpretation of the results; the relevance lies in the possible repercussions.

The decision to marry or not rests with the couple, taking into account their own and common interests. Legally, a disease can represent an impediment in some countries.

In history, physical or mental illness was considered a decisive impediment to making a marriage; some health conditions were considered limiting due to limitation for conjugal life or procreation. Currently, the opinion of the couple who decide to marry despite any illness is taken into account.

Each evaluation provides specific data of interest about the health of both men and women. The prenuptial examinations detect normal conditions or alterations that will affect the conjugal and reproductive life. Comprehensive clinical evaluation, mental evaluation, laboratory, and genetic testing are taken into consideration.

General medical examination

The purpose of the physical examination is to determine the fitness and health of the couple before marriage. The existence of diseases or predisposition to suffer them can alter the couple's dynamics and affect the relationship. If the couple wishes to have children, their ability to have a healthy and productive sex life must be assessed.

Anamnesis

Every medical evaluation has a previous step: the anamnesis or questioning. The doctor will ask questions regarding habits, previous illnesses, allergies, surgeries or chronic diseases.

Family pathological history will also be evaluated in order to determine predisposition to diseases such as diabetes or heart disease.

Physical exam

It is the systematic evaluation organized by devices and systems. The results of this exam will determine health and fitness for marital life. The presence of diseases unknown to the patient or the predisposition to have them can result from this evaluation.

Urological and gynecological evaluation

It is the part of the physical examination that evaluates the urogenital system of the couple. In the case of men, it will be determined whether it is possible to have sexual intercourse and reproduction.

The gynecological examination includes the examination of female external and internal genitalia and cervical cytology -Papanicolau- given its importance in reproduction.

The physical examination will be complemented with laboratory tests if necessary. It is not a mandatory evaluation, but it is considered part of the premarital exams.

Mental examination

Deciding to start a home is a conscious decision and with mutual consent. In addition, the couple must ensure their compatibility and psycho-affective state.

The objective of the mental examination is to verify the psychological or mental health of the couple. This examination may also reveal psychiatric disorders that impede marital union.

Laboratory

Laboratory tests are often the most important part of the prenuptial evaluation. The legislation of many countries requires mandatory diagnostic tests for infectious-contagious diseases.

Tests to determine blood group and Rh are of vital importance at the time of marital union and, many times, they are required.

Lab routine

They are the tests of general use to determine the state of health of the individual. The most common tests are:

- Blood count and platelets.

- Renal profile, such as the determination of urea and creatinine.

- Transaminases and bilirubin count.

- Blood lipids, such as cholesterol -total and fractionated- and triglycerides.

- Uroanalysis

Serology for infectious-contagious diseases

The most important tests correspond to the determination of HIV and VDRL, the latter to rule out syphilis. Knowing the results of these tests is relevant before getting married due to the contagious nature of these diseases. Other tests include:

- Serology for hepatitis B and C.

- Chlamydia.

- Tuberculosis.

- Hansen's disease or leprosy.

Blood group and Rh

Its importance lies in the incompatibility of the group -but especially of Rh- which can put the reproduction of the couple at risk.

Currently there are preventive measures to avoid the consequences of incompatibility, such as prior immunization with Rho D immunoglobulin (Rhogam).

Fertility tests

They are not routinely performed before marriage, but could be part of the prenuptial evaluation. They are a series of tests designed to verify the reproductive capacity of the couple.

Genetic testing

They are intended to investigate genetic alterations or hereditary diseases in the spouses. They also assess the likelihood of genetic defects or malformations in your offspring.

They include DNA tests, chromosome study and karyotypes. They are not mandatory; However, there are criteria to perform them:

- Family history of genetic conditions or diseases of any kind.

- Man or woman are carriers of a known genetic alteration.

- Exposure to teratogenic agents.

- Obvious chromosomal alterations.

- Consanguinity of the contracting parties.

The results of a genetic test provide data that suggest the possibility of congenital or chronic diseases in the offspring. The risk of having a child with a genetic alteration implies decisions that the couple must make:

- Do not perform the marriage

- Decide not to have children, if they plan to marry.

- Consider adoption as an alternative

- Make the decision to have children despite the risk.

- If conception occurs, consider termination of pregnancy.

- Consider the psychological, economic and social implications of having a child with a genetic disease.

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