Abstract: Vaginal or uterine bleeding due to trauma [1] does not render a woman niddah. Therefore, a patient may request a medical examination to check for a lesion that could be the source of her inter-menstrual bleeding.

Discussion: Only uterine bleeding not due to injury renders a woman niddah. Therefore, if a lesion found on speculum examination could possibly explain the bleeding the woman is experiencing, this is important information for the woman to relay to her halachic advisor.

Bleeding from injury or a lesion is known as dam makkah or "blood of a wound."  It does not make a woman niddah even if the source is the uterus. However, some authorities hesitate to be lenient with uterine bleeding out of concern that some non injury related bleeding may have commenced as well.

It must be stressed that the medical definition of trauma and the religious definition of a "makkah," or wound, do not completely correspond. Jewish law is concerned with any lesion that could cause bleeding, even if it is of no medical significance - for example, ectropion [2]. Furthermore, if non trauma induced bleeding is suspected, the additional presence of lesions is of halachic significance. Therefore, all findings should be reported, regardless of their medical significance. Answering the questions that appear on the form available here will be of much assistance to the couple.

The rabbi's ruling about the bleeding will depend on a number of factors, including the point in her cycle at which the bleeding occurred. Therefore, it should never be assumed that, if a particular finding was permissible for one woman, the ruling will be the same for all similar lesions.

Implications for Patient Care: Not every form of vaginal bleeding renders a woman niddah. If bleeding is known - or at times even if suspected - to be due to injury, it does not make her niddah.

The niddah observant woman will at times, request a speculum examination  to search for potential lesions or injury that may cause vaginal bleeding but not render her niddah.

An accurate, non-judgmental report of the physical findings can be of much assistance to your patients.

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. 10th 2006.

[2] Stenchever MA. Pelvic examination. In: Comprehensive Gynecology 2001, 4th ed. St. Louis: Mosby, 2001;147.