Abstract: Vaginal bleeding renders a woman niddah only if it originates in the uterus. If the cause is not uterine, the woman does not become niddah and the couple are spared the burden of physical separation. Therefore, if a non uterine souce of bleeding is identified, the woman should be notified of this finding.

Discussion: Only vaginal bleeding whose source is the uterus can bring on the halachic status of niddah. Therefore, spotting from vaginal dryness would not make a woman niddah. Neither would an abrasion of the visible cervix. When the source is the cervical canal, the woman's status is a matter of halachic debate [1].

Lesions that can bleed in the genital area (e.g., hemorrhoids) are a potential source of confusion as they can lead to situations such as blood on toilet paper [2]. However, if these non uterine causes are known to be the source of the bleeding, the woman is not niddah.

At times, when the source is not clear, a woman may turn to her physician for a physical examination to look for non uterine sources of bleeding. Answering the questions that appear on the form available here will be of much assistance to the couple.

Implications for care:

A woman should be notified if a non uterine source is found for vaginal bleeding.

At times, a woman will request a physical examination to look for such non uterine sources.

Medical References

[1] Goodman A. Overview of the differential diagnosis of genital tract bleeding in women. In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2006. Accessed Sep. 10 2006.

[2] Clinical policy for the initial approach to patients presenting with a chief complaint of vaginal bleeding. American College of Emergency Physicians. Ann Emerg Med 1997 Mar;29(3):435-58.