Halachic questions may arise in connection with gynecological exams and procedures. This lesson gives you the background information to help you ask the right questions to your health care provider and your rabbi.
Because the halacha in this area is not always clear cut, and individual circumstances may lead to variations in halacha, it is important to consult with your rabbi on these issues. For the more common procedures such as a Pap smear, you can ask a question once and then know what to do in the future. For more invasive procedures, especially as the technology is likely to change over time, a question should be asked prior to each procedure.
Rabbis have different approaches to these questions, and the specifics of each individual case are slightly different. Therefore, you should not just assume that because your friend received a particular ruling that it applies to you as well. Similarly, your doctor's role is to provide medical opinions and information and not to issue halachic rulings.
Two halachic principles that are especially relevant to gynecology are bleeding from injury (dam makkah) and uterine dilation.
Bleeding from Injury
Some gynecological examinations and procedures cause vaginal bleeding. Vaginal bleeding makes you niddah only if it is from the uterus and is not due to injury. Bleeding from an injury or lesion is called dam makkah and does not make you niddah. Thus, bleeding that clearly originates in the vaginal canal, as well as bleeding from a lesion or injury to the cervix (the neck of the uterus), is dam makkah and does not make you niddah. There is halachic debate as to whether or when bleeding that is definitely from the uterus can be attributed to an injury inside the uterus.
It is sometimes difficult to determine the exact source of vaginal bleeding. The degree of certainty needed to attribute bleeding to dam makkah varies depending on whether you are already niddah (such as during the shivah neki'im) or have already been to mikveh.
There is a halachic principle "ein petichat hakever b'lo dam", i.e., uterine opening is presumed to be accompanied by bleeding. Therefore, if the cervix is instrumentally dilated past a certain size, you can become niddah without detecting any bleeding. There is a debate as to the minimum size of dilation for this halachic presumption to apply (opinions range from four to twenty millimeters). Most routine gynecological procedures do not involve this degree of dilation.
Scheduling Examinations and Procedures
If you have a choice, you will probably prefer to schedule procedures in such a way as to minimize extra time as niddah. Therefore, it's a good idea to consult with a rabbi prior to scheduling a procedure. The information that the rabbi will need is:
- What is the name of the procedure?
- Is any instrument entering the uterus or cervix? If the latter, the inner or outer opening?
- If an instrument is entering the uterus or cervix, what is its diameter?
- Is bleeding expected from the procedure?
- If so, what is the most likely source of the bleeding and for how long can it be expected to last?
- Is there a medical requirement to perform the procedure at a particular point in the menstrual cycle?
In general, if a procedure will make you niddah it is most convenient to schedule it close to a time when you will be niddah anyway. If a procedure will not make you niddah, but might cause some vaginal bleeding, it is best to avoid days on which you will need to do bedikot (shivah neki'im and veset days). If a bedikah will be required on the day of or within a few days after a procedure, ask a halachic question before the procedure (or, at least, before doing the bedikah).
Resources for your Doctor
Our website for medical professionals, www.jewishwomenshealth.org, has forms you can print and give to your physician to fill out before scheduling a procedure, or after performing one. You can also refer your doctor to the site, or print out articles relevant to your specific situation for him or her to read.
The next few lessons will address the most common gynecological examinations. You can find more information about other procedures, and about gynecological conditions, on www.yoatzot.org, and at www.jewishwomenshealth.org.