Abstract: Ejaculation of semen outside the context of intercourse is a halachic prohibition known as hotza'at zera levatalah or hash'chatat zera. This precludes suggesting male masturbation as a medical solution without careful prior discussion with a couple's rabbi. This also indicates special considerations in the procurement of semen samples for infertility diagnosis and/or treatment.
Discussion: According to Jewish law, ejaculation of semen is meant to take place in the context of vaginal intercourse. Ejaculation at other times raises concerns about hotza'at zera levatalah, generally translated as wasting of seed, or hashchatat zera, the destruction of seed. There is much rabbinic debate about the scope of this prohibition, but it clearly subsumes a number of issues:
1) Male masturbation is prohibited. (Some authorities consider this an independent prohibition, rather than a subcategory of wasting seed.) This means that mutual masturbation is not an acceptable solution when a couple is medically precluded from having intercourse . In cases of sexual dysfunction, masturbation without intercourse should not be offered as part of the treatment plan without careful prior discussion with the couple's rabbi. Masturbation is also not the method of choice when procuring a semen sample.
2) Producing a semen sample for diagnosis and/or treatment of infertility is not a simple procedure to permit within Jewish law. For this reason, rabbis may request that the wife be tested prior to her husband, even if the chances are equal for male and female factors in infertile couples . They may require a minimum amount of time of marriage before permitting semen testing. Rabbis may request that post coital testing be done prior to direct semen analysis . Although this test is no longer commonly used in many infertility practices , there may be room to do so in younger couples due to halachic concerns. Alternatively, the specimen may be collected during intercourse in a condom rather than directly into a specimen container. The quality of the sample obtained in this manner is also likely to be more accurate . Some rabbis prefer that a pinpoint hole is made in the condom so sperm can theoretically exit. If the physician feels that this will invalidate the test, this should be conveyed to the couple's rabbinic authority.
3) Coitus interruptus is a prohibited method of birth control. This is derived from the biblical story of Er and Onan (Genesis 38), where God's displeasure with this practice is expressed.
4) Barrier methods of contraception that do not allow the flow of semen into the vagina are prohibited. This is the problem with the use of condoms. Some authorities maintain that the diaphragm and sponge also present this problem.
Implications for Practice: Therapeutic suggestions for masturbation generally cannot be used in this patient population. If felt to be necessary, rabbinic consultation should be pursued.
Modifications are needed in the diagnosis and treatment of halachially observant couples experiencing infertility in order to provide culturally sensitive health care.
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 See: Practice Committee of the American Society for Reproductive Medicine. Optimal Evaluation of the Infertile Female. Fertil Steril 2004 Sep;82 Suppl 1:S169-72.
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