Medical experts say:
•No test can determine if a man can have sex
•It’s an abuse of reproductive health privileges, rights
•Lawyers, entertainment celebrities hold divergent views
By Sola Ogundipe & Chioma Obinna
“Let your private parts be exposed! Your genitals will be on display. I will get revenge. I will not have pity on anyone” – Isaiah 47.3 (New English Translation version). Such is the force of the missile dropped by the leadership of the Redeemed Christian Church of God (RCCG) on its congregation. No doubt echoes of its effect will be felt for a long time to come.
In a memo entitled “Directive on Pre-marital examination”, the RCCG Mission Authority declared that it has “observed the recurrence cases of marital crises resulting from falsehood, especially in the case of undeclared or unconfessed reproductive/genital status. The church authority has therefore made it mandatory for any intending couples to undergo premarital medical examinations which should include genital test that must be done at any government approved hospital.”
Debate however still rages in the Christian community over the mandate for premarital genital testing. Is it right, is it wrong? What does genital test entail and how will it be carried out? The Church is going too far. It’s a doctrine, not biblical. It’s an invasion of privacy. The comments are endless.
Many brethren have been trying to rationalise the directive. However, to the more discerning, God has spoken. In many ramifications, the directive that intending couples must present their genitals for mandatory pre-marital examination and evaluation may sound far-fetched to some, but to others it makes a lot of sense.
There were cases where men who knew they were impotent and could not perform conjugal obligation would fail to disclose their condition to the ladies they wanted to marry which would only be discovered after marriage since the church frowns at premarital sex. On the part of ladies, some have been discovered not to have female sex organs which would not be known to the man until after the marriage. Such marriages are built on falsehood and are doomed to fail. And the major reason the church now insists on genital test is to reduce the increasing cases of divorce. And for this many have thumbed up for the church, arguing that the advantages outweigh the disadvantages as far as sustaining marriages is concerned.
According to a psychologist and behaviour change specialist “the genitals are sexual organs of generation that are essential to the existence and perpetuation of the human race. We are sexual beings; sex is a force of nature and an elemental instinct of survival. The Church recognises this need, hence the whole point of the demand for genital testing is to ensure that intending couples go into marriage fully aware of all potential conjugal issues they might have to confront, rather than experience a rude awakening on the day after the wedding night or suffer more severe after effects of a marriage based entirely on falsehood. “
Biblical passages specifically highlight the essence of sexual intimacy in marriage. 1 Corinthians 7:3 instructs: “The husband should give to his wife her conjugal rights, and likewise the wife to her husband”. Ecclesiastes 4:11 is even more straightforward which says “again, if two lie together, they keep warm, but how can one keep warm alone?”. Deuteronomy 24:5 is very specific: “When a man is newly married, he shall not go out with the army, or be liable for any other public duty. He shall be free one year to be happy with his wife whom he has taken” .
Some religious beliefs deify the genitals. For instance in Hinduism, Yoni Pooja (vagina worship) holds sway. A Yoni Pooja is a sacred ritual in which the yoni (vulva) is worshipped. In contrast, in Bhutan, the worship of the penis is legendary.
Christian faith has strict rules about the genitals and there are specific biblical directives about genitals. For instance, Leviticus 18:7-11 gives detailed instruction about sacredness of genitals and the need to treat them with reverence.
Genital abnormalities
Nevertheless, medical experts describe the genitourinary and rectal examination as an essential part of the overall health assessment of a man and a woman, not necessarily for nuptial purposes. They argue that a complete and efficient examination will lead to the identification of current or potential health problems.
For instance, research has shown that just one out of every four or five young men is producing good quality sperm, and the average volume has been steadily declining. Generally, male fertility has fallen over the last 50 years for various reasons. More men are being diagnosed with problems of abnormal sperm shape (morphology), movement (motility) or function. There are infections that can interfere with sperm production or sperm health, as well as ejaculation problems such as retrograde ejaculation (when semen enters the bladder during orgasm instead of emerging out of the tip of the penis).
Disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome instead of one X and one Y — cause abnormal development of the male reproductive organs. It isn’t an inherited condition. Many men aren’t diagnosed with infertility until they realise they’re unable to father a child.
While the pronouncement by the RCCG leadership to include premarital genital test in the list of tests by intending couples may sound odd to many Nigerians, stories abound of cases of marriages that have crashed based on false declaration of reproductive health status among others. Again, many couples have continued to die in silence under the belief that God does not sanction divorce.
Cases of marital violence
There was a well celebrated case of misplaced aggression in marriage arising from unconfirmed infertility of Jackline Mwende, a Kenyan woman whose hands were butchered and she was left with multiple injuries to her head after a brutal attack by her husband, who claimed it was her punishment for not being able to conceive during their seven-year marriage.
Jackline’s husband, Stephen Ngila, allegedly attacked her at their home in the night with a machete, with the intention of “shutting her mouth permanently”. But much later a hospital test revealed that it was he, not the woman that had an infertility issue. To further erase doubts, Jackline later gave birth for another man, but the damage had been done. A pre marital screen test would most likely have averted the trauma she suffered.
Another example was that of Innocent Obi who narrowly escaped an impending marital failure with his former girlfriend. He said,”I almost became a victim but I narrowly escaped. It was a blessing in disguise.”
Innocent was in a relationship with a girl he was planning to marry. Just like every other man, his dream was to marry a beautiful and educated woman which his girlfriend, Ifeoma, represented at that time. But each time Innocent attempted to make love with her, she screamed in pain even when he (Innocent) had not penetrated. After about three or four attempts, Innocent decided to let go of her.
“I was scared even though she was a paragon of beauty and represented everything I wanted in a woman, I could not continue. We were not sexually compatible and that was the end of our relationship,” he told Saturday Vanguard.
Perhaps if Innocent had met her in the church, maybe they would have been joined together in holy matrimony and later discover the problem. The church feels it is important to know if the person intending to marry has the right genitals to consummate the marriage.
Experts however, argue that whether genital testing is right or wrong, the bottom line is that it is in every man and woman’s interest to take advantage of premarital tests if they are getting married. Even if a woman is not getting married, going to the gynaecologist is essential to health. You don’t need to wait until you’re getting married to start being concerned with your sexual health.
Premarital examination
A premarital examination provides the intending man and woman a safe, non-judgmental environment to talk and ask questions about sex. Every woman in particular needs that. Many women who are getting married are anxious about preparing to have sex for the first time. They have many questions and a doctor’s professional insight can really be helpful, especially since they can do an exam and can answer questions specific to them and their intending husband.
Simply put, a premarital exam is a basic gynaecological exam where you establish a relationship with your doctor before you begin having sex. Since there’s no real definition, the exam can include almost anything. Premarital exams provide important information about women’s health, like self-breast exams and pap smears. They also provide information for men about their health, as well.
Genital exams are gender specific to evaluate the health of the reproductive system. However, for a man and woman, such exams are invasive, and require informed consent. The tests may not however, provide absolute prediction of future health status.
For instance, a “pelvic exam” not necessarily genital examination is done medically or clinically by a urologist or gynaecologist or other trained medical personnel. Urologists are physicians who specialise in the genitourinary tract, that is, the kidneys, urinary bladder, adrenal glands, urethra, ureter, male and female reproductive organs and fertility. They are trained in the surgical and medical treatment of diseases that affect these organs.
A urologist will normally request a urine specimen, and may make enquiries about lower urinary tract symptoms, incontinence and/or sexual health. The examination often starts with requirement of a detailed medical history focused on the genitourinary system, underlying health problems and a complete review of all body systems. There may be need for additional tests, such as blood counts, kidney function, or testosterone levels.
Medical experts speak
When Saturday Vanguard sought the views of medical experts on how genital test could be carried out, their consensus was that there is nothing like that in medicine all over the world
A Urologist with a Lagos State owned General Hospital, who spoke under the condition of anonymity said such pronouncement on genital testing is an invasion of patient – doctor confidentiality
According to the urologist, there is no medical term that is called genital testing, however, a doctor can examine anybody’s genitals but must have a purpose why he or she is examining the genitals.
“There are various reasons why you can examine anybody’s genital. The truth is that if anybody is coming with the scenario before marriage, there is something they are interested in such as fertility or ability of the man to have erection. If it is for a woman, there is very little thing you can do to determine if she is a virgin or not because in terms of physical examination, if the woman is a virgin, you cannot do vaginal examination because it is against the ethics.
But you can do ultrasound to know whether the womb is there or not but it cannot tell you whether the person is fertile or not. Even if the doctor detects something wrong with the patient, he cannot disclose it without the permission of the patient because of the doctor – patient confidentiality.
“For men, you can look at the size of the testes to see if it is okay but ultimately, you will need laboratory tests to determine the sperm count. It is not just about looking at the patient, it goes beyond that. Even though all the tests are normal, you cannot say that if the couple get married, they will not have some problems with fertility. Unless you just want to play God, you cannot cover all the places. For anybody participating in genital testing, you will be breaching patient – doctor confidentiality.”
He further explained that the cause of a man not being able to have sex with his wife could be weak erection which can affect men at any age but increases with age.
The urologist explained that the condition can be corrected and treatable and should not be used as basis of stigmatisation against anybody. It could occur as a result of the problem of the mind that is psychogenic, and could be due to serious health problems. But once the underlying medical problem is detected, the person may be able to achieve erection with the aid of drugs.
He said that weak erection could be treated if both partners work together, regretting that churches are coming in because people are not willing to come together to solve the problems. It is amenable to treatment.”
No test can determine if a man can have sex — Dr. Abdulwahid Niran Saliu, Urologist, General Hospital Lagos
In his own views, a Urologist with the General Hospital, Lagos, Dr. Abdulwahid Niran Saliu argued that no doctor or individual will determine the ability of a man to have conjugal relationship with his wife by mere looking at the genitals.
“You cannot look at a man’s genitals and say this one can have sexual intercourse with his wife. Do they want to evaluate the size of the man’s penis? They should come out to say what they want to evaluate. It is a very delicate matter. If it is to evaluate whether the man can have intimacy, no tests can reveal it except a man meeting women. It cannot be judged by the size of the penis whether small, normal size or a little more than the normal size. That is not what will determine erection.
“In terms of fertility the first test as far as a man is concerned is seminal fluid analysis. Being able to have erection and also have intercourse is also not a guarantee that the man can be able to father children. A man can be able to have erection, have adequate sexual intercourse but will not be able to procreate because there is a problem with the seminal fluid.
“Are they going to be requesting for the person’s seminal fluid and have an evaluation? How will the man produce it or will they do masturbation? If it is to evaluate fertility it is by sperm test and Seminal fluid analysis. If there is defective, that is when you now probe further to find out what is the defect. You can look at the man’s genitals if the testes are there. Are they of normal size? Then check the hormone profile of the man etc. But the first thing to evaluate for fertility is the seminal fluid.
“No doctor in this world will look at the man’s penis and say okay this man will be able to have sexual intercourse. The way out is that they can send the man to a doctor who will now ask him if he is having erection. But that is subjective. A patient can decide to tell the doctor he has erection when he does not have erection. We usually ask from somebody who has come to present himself for examination complaining that he has difficulty having conjugal relationship with his wife. So we will now ask specific questions on why the man has difficulty having conjugal relationship with his wife.
“But in the case of a young man who has not got married and come for evaluation, you cannot look at his penis and say he can have conjugal relationship. However, you can look at the hormones, genitals and see whether the testis is down but all these do not guarantee a man being able to have sex,” he stated.
It’s an abuse of reproductive health privileges, rights – Prof Oluwarotimi Akinola, President, Society for Gynaecology and Obstetrics of Nigeria
On his part, the President of the Society for Gynaecology and Obstetrics of Nigeria, SOGON, Prof. Oluwarotimi Akinola, said subjecting couples to such examination is an abuse of reproductive health rights and privileges.
Akinola who declared that there was no such test in medicine said persons can only be subjected to genitally examination to ascertain their sexual organs.
“I don’t see how it is medical or ethical. I don’t honestly know anything called genital test. There is nothing called genital test. If it means genital examination that is to know whether he is a man or she is a woman, the only thing they will do is just to inspect. How do you know it? You strip them and examine their sex organs and ensure it is what it is proclaimed to be, check if they have male or female organs.
“Even as a doctor, I don’t have a reason for looking at anybody. Reproductive health wise, it is an abuse. People have sexual rights in reproductive health and those privileges and rights are being abused by subjecting them to such examination. I cannot pass any judgement, but it is an abuse.”
He advised that such a pronouncement should be revisited as there is nothing like genital test.
It is good to know your future partner’s fertility potential -Prof Oladapo Ashiru, CMD, Medical ART Centre, Lagos
Throwing more insight on the issue, Prof Oladapo Ashiru, CMD, Medical ART Centre, Lagos said “A man may not be producing any sperm or may have low sperm production capacity. For instance if a man was exposed to mumps infection during early childhood, it can lead to a condition known as Mumps orchitis where the mumps would spread to affect the testes. And this would lead to permanent testicular damage that is irreversible. Such man would obviously require donor sperm to become a father.
“A man with undescended testes will have fertility challenges. Once a male child is born, it is important to examine the testes to be sure they are descended and complete. Undescended and incomplete testes would not function properly as they cannot produce sperm. However, the anomaly can be surgically corrected under age of 2.
“Other genital abnormalities that may occur in men may involve the sperm-producing pathways such as the vas deferens (tubes that carry the sperms) and urethra. It is not a bad idea for couples to make sure everything is intact and even if there are problems, they would know what they are facing.”
According to Ashiru, one of the commonest genital abnormalities for women is in the uterus. “It may be placed abnormally, instead of joining to form one cavity, it may remain as two cavities. These things can cause miscarriages. Blocked fallopian tubes are also common.
“These abnormalities, which are preventable, are usually caused by wrong programming of genes during development.. They affect the programming mechanism for development, so when the male and female are being formed, if the gene misinterprets the information, there could be failure in the programming. They are usually caused by man’s own activities.”
Ashiru explained that common factors such as exposure to environmental toxins like pesticides can affect the reproductive capacities of unborn babies even up to the 3rd generation.
He said it is now being recommended that it is not just enough to examine yourself medically when you are getting married, it is also important to do so when you are preparing for pregnancy. “There are basic measures to take, for instance it is recommended that every woman must take folic acid before pregnancy.
“In your own interest, you need to avoid some food like stockfish and any large fish that contains heavy metals like lead and mercury. If you want to have healthy baby, husbands and wives should treat their bodies the way they would treat their house when expecting an important visitor. What you must do is clean up in preparation. A clean body is a healthy body.
“There are some basic premarital tests that I would support, for instance it is good for a woman to know that her future husband has fertility potential. She must know whether the man is virile and can produce viable and normal sperm, and in case he cannot, there are ways to treat it. The important thing is to know the problem.
“As for the woman, her future husband wants to know if she ovulates, whether her sex organs are normal or whether she is a hermaphrodite. There should be a medical report. It is important for couples to know their genotype before marriage. Even if they are both AS, they can marry, but they should know the consequences and possibility of having a baby with SS genotype. They could be assisted to consult a centre that can help them to have a normal baby. I consult almost monthly to couples that are AS and want to marry. They know what they are getting into and once they know that we help them get normal babies.
“It is important that couples go through the tests to ensure that the marriage is not being desecrated. There are many things that can cause problems in a marriage and we should just remove them out of the way. There is a lot of stress on women if they are unable to get pregnant, but there are times that it is the man that is responsible yet the woman is blamed.
“If the man knows he has problems, the woman would be in position to know she is marrying him with such problem and they would openly and readily look for solution. What the church is doing is in the right direction, but more should be done in addition to genital exams.”
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