Congratulations on your engagement! Hopefully, your partner asked beforehand about your allergies to precious metals and beautiful gemstones. Joking aside, the health issues that will arise in your future together are unavoidable and the way you talk about these matters is crucial to your success as a couple. Health questions you need to ask each other before tying the knot What are your wishes if something were to happen to you unexpectedly? This question is intriguing because its content is implied even in the marriage vows themselves (“Til death do us part”), says Michelle Katz, MSN, LPN. It may seem gruesome to enter into a discussion about your end-of-life wishes just as you are embarking on the start of a new life together. But your partner will likely be left to make medical decisions on your behalf if you cannot make these decisions on your own and it is crucial that you discuss your preferences before faced with an emergency situation. “A power of attorney/advance directive should be signed immediately, even with the marriage certificate,” says Katz. What health problems run in your family? Make sure to ask about cancer, heart disease, diabetes, and Alzheimer’s disease. These conditions often have a hereditary component, so when you ask about these conditions you are not only asking on behalf of your partner and his or her potential future health challenges but also about the health risks for your future children. It is also important to ask about more explicit single-gene disorders, such as Huntington’s disease, Fragile X syndrome or bleeding disorders. What mental health concerns run in your family? Key issues that you should know about include alcohol or drug abuse. Ask if there are people in the family with a history of depression, suicide attempts, or personality disorders. This may feel uncomfortable, but knowledge is power. Not only are you protecting your partner by having this knowledge, you are also educating yourself about the genes that may cause future problems in your marriage, or may pose challenges for your children. How are we going to take care of our parents in the future? Ah, the aging parent question. In the dawn of ever-rising life expectancy and healthcare costs, it may be just as important as your vision for raising children. You may be surprised about your partner’s answer to this question. Maybe he or she envisioned having sick or elderly parents pursue care at an independent facility, citing their fiercely independent spirits. Or, maybe your partner always planned on having an aging parent move into his or her home. Families can vary radically on their views of how to care for the elderly, and this issue can put a strain on a marriage if two people do not see eye to eye. The options available currently in our society are daunting — and costly. “I just had a situation where a patient’s parents were sent to a skilled nursing facility and now long term insurance is running out,” says Katz. Make sure to discuss your desires long before you have to make tough decisions. Do you want to have kids? This may seem obvious. But sometimes it is not discussed before marriage, which can cause some major issues later on, says Dr. Allen Kamrava, MD, MBA, a board-certified surgeon in Beverly Hills, CA. Make sure to discuss how many kids you would like to have as well. Kamrava reports that throughout his years of practice he has also seen couples struggle because they have not had a conversation about their views on pregnancy complications. An important question to ask, he says: “If prenatal screening of your baby shows some issue, would you want the child no matter what, or would you wish to have an abortion?” Depending on your partner’s answer, it may be wise to discuss the type of prenatal screening that you and your partner would be comfortable with because certain screens can have false positive results. Have you ever been pregnant before? This question is important to ask ahead of time because it will come up in future medical visits, especially if you are expecting to have children. You do not want your partner to be blind-sided by new information at your first prenatal visit. Past pregnancies are important because they can have an effect on future pregnancy prospects, especially if you and your partner end up having infertility concerns later on. Have you ever had an STD? “Engaged couples should have full disclosure of health issues prior to marriage,” says Jim Hjort, LCSW, a licensed psychotherapist. One very important topic to ask about is about STDs, says Hjort. This issue transcends the obvious concerns about a personal contraction of a disease, to more important issues of future fertility. “STDs can cause problems with conceiving later in life. It’s important to discuss the desire to have children and the possible hurdles to overcome in order to make that dream a reality.” Furthermore, STD status can pose questions about fidelity years into a marriage, says Nicole Prause, Ph.D., a couples therapist. Prause says she has seen this issue arise many times in her practice. “The overwhelming majority of people with sexually transmitted infections do not know that they have the infection,” says Prause. “Couples should ask each other to get a full panel of tests for infections transmitted during sex. This can save the significant turmoil of discovering that the infection has been shared late in the marriage and having to worry about infidelity.” Have you ever used IV drugs? Despite his or her insistence that life began the day you two met, your partner had an existence before you came into the picture. It does you no good to assume that there was no dangerous experimentation that took place just because you are afraid to ask. If your partner did use IV drugs, he or she is at risk for harboring chronic blood-borne illnesses such as Hepatitis C and HIV and passing them along to you. If your partner answers “yes” to this question, he or she should get tested. How to have these conversations This discussion can seem daunting. Lisa Bahar, LMFT, a licensed marriage and family therapist, suggests that approaching the conversation as a way to identify potential areas of vulnerability in the marriage may make it seem less intrusive. “Be open or willing to respectfully discuss family origin and issues that challenged your family dynamics, and consider seeing a family therapist that can explore a genogram to gain further knowledge,” she says.