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Getting married- Essential things to check out before tying the knot! (October, 2005)

Premarital check for the prospective bride With the divorce rates on the rise ascertaining the compatibility of the couple on more practical & realistic grounds is more important than stars & planetary configuration in the horoscope. Matching the likes & dislikes of both partners can assess emotional compatibility. Certain medical checks ensure physical well being of both & improves the physical compatibility.

In earlier newsletters health issues in males, which can act as deterrent for healthy married life, were discussed. In this issue we would like to cover the issues, which are important for the bride.

Problems with the menstrual cycles: Regular cycles indicate that the female reproductive tract & its function are intact. Some girls have certain menstrual cycle problems that can affect procreation & married life. They are:

Amenorrhoea: Lack of periods is termed as amenorrhoea. It can be primary or secondary. In primary amenorrhoea a girl does not attain menarche at all while in secondary amenorrhoea cycles stop after attaining puberty. The problem can be in the reproductive tract or with the hormones. The problems with reproductive tract could be: non-development of the uterus, tubes & vagina (MRKH syndrome), vaginal septum blocking the tract and testicular feminizing syndrome( genetic male but has external genitalia like a female & has breast development at puberty). In girls with absent vagina a functioning vagina can be created by progressive dilatation or by surgery. They can have a normal sexual life but will not be able to bear children. For girls with testicular feminizing syndrome testes have to be removed in addition.

The hormonal defects for lack of menses are ovarian failure, defects in pituitary gland (the master gland) or others like anorexia nervosa, exercise & stress induced. Hormone assays are done to identify the problem & to guide the treatment. Some of these defects can be rectified.

Infrequent cycles: Infrequent or irregular cycles is a common problem seen in girls. Irregularity is because of anovulation or abnormalities in thyroid hormones or milk hormone. Anovulation means the ovary does not release the eggs. Polycystic ovarian syndrome is a condition in which a girl has irregular cycles, acne, hirsutism*, obesity & an ultrasound exam shows multiple small cysts in the ovaries. This condition is quite common & is due to insulin resistance. Treatment includes weight reduction. (* Abnormal hair distribution like a male.)

Other menstrual problems like painful menses, too frequent cycles or heavy flow during periods can be bothersome & it is better to have a check & sort out these before marriage.

Breast problems: Small breast size is a common concern in young ladies. It may rob the self-confidence of the woman. Every woman's body has a predetermined genetic breast size. Breast growth begins at puberty & by about 18 - 20 years in most women the breasts are at their adult size and shape. Various treatment modalities have been tried for enhancing the bust size- herbal creams, devices to stimulate the breast, exercises etc. Upper body exercises will increase chest muscles but may also decrease fat in the breast, which is the main source of breast size. The only way to actually increase the size of the breasts is usually to gain weight (fat deposition). For women who feel there breast size is too small surgical enhancement is an option.

Other breast problems are retracted nipples, extremely large breasts, accessory nipples, and one breast smaller than the other.

Familial diseases & marrying within the family: There are some diseases that can be passed on to next generation. Many of these hereditary diseases are recessive disorders and the chance of having an affected baby increases with marrying within the family. For couples with known familial diseases a genetic counseling before marriage will help.

Hymen reconstruction: Some women want restoration of virginity. The hymen can be recreated by plastic surgery. But before requesting for surgical repair or replacement of hymen to restore virginity it is important to know that it amounts to tricking the future husband. The greatest delight and firmest foundation of marriage is total openness, trust and acceptance. By going through with this deceit you would be turning your back on this joyous freedom and security. In terms of self-worth, a pure conscience and joyous freedom from guilt, your innocence can be restored without resorting to surgery or self-deceit.

Information on family planning and contraception:
Apart from identifying & dealing with the problems all the more important issue of family planning & contraceptive choices can be discussed at the premarital checks.

The other benefits of premarital check is that the myths & facts about sexually transmitted disease can be discussed.

And finally the bride (and the parents) can have a free and frank discussion on any other aspect of sex or sexuality and any other health matter with her Gynaecologist.

Hence do cast your daughter’s medical horoscope well before you plan to have her married, to ensure a happy married life.

Dr. Sukhada Rao, MBBS, M.D ( Ob. & Gynaec Surgery),
Consultant Obstetrician & Gynaecologist & Laparoscopic Surgeon,
Dr. U Mohan Rau Memorial Hospital.

Additional Comments (July, 2009)
Questions relating to Menstrual problems, PCOS, under development of breasts and whether to undergo “Hymenoplasty”, seeking details are common. Ask your Doctor

Updated on 01.07.2009.

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