Hysterectomy

The question below was submitted to www.yoatzot.org, Nishmat's Women's Health and Halacha (Jewish Law) website for the lay public.

"I am a 48 year old woman whose gynecologist has recommended a hysterectomy, leaving my ovaries intact. I have drastically heavy bleeding during my periods, so bad that I can't leave my home for the week because of passing clots and loss of huge quantities of blood. I have a very hard time getting to the mikveh, because often the day following my hefsek, I am staining again. Also, my uterus is very prolapsed. I spoke to a young rabbi, but our communication was poor and brief. I would be very grateful if you could answer the following question: If my ovaries are left in--the rabbi said I would still have niddah problems. Is this the case, and why? Is hysterectomy permitted halachically?"

This question illustrates the need for clarification of procedures both for the patient and for the rabbi to whom she may turn. It is often helpful to give a patient written information to convey to her rabbi.

Niddah following hysterectomy

The niddah status results from uterine bleeding only. Therefore, as long as the entire uterus is removed, a woman can no longer become niddah following a hysterectomy, regardless of whether her ovaries remain.

If a woman is already niddah when she undergoes a hysterectomy, she will have to count seven clean days and immerse once after the procedure to permanently exit the niddah status. This may take several weeks. Although the vaginal bleeding that follows a hysterectomy does not render her niddah, it will impede the internal examinations (bedikot) of the seven clean days.

As for anyone undergoing surgery, attention should be given to possible impediments to immersion. For example, the woman should be told for how long any external sutures will need to be left in place before they are removed by a medical professional. Please see Medical Devices as Barriers to Mikveh Immersion for more information.

Permissibility of hysterectomy

There is a halachic concern about hysterectomy because it is a form a sterilization. Sterilization is generally prohibited as an rabbinic extention of the biblical prohibition of castration. There is also halachic caution regarding any elective surgery. Nevertheless, when medically indicated, particularly if a woman is no longer fertile, hysterectomy is halachically permitted.

Hysterectomy to prevent niddah

In cases where a woman is contemplating a hysterectomy to prevent being niddah, it is essential to assure that the bleeding she is experiencing does in fact make her niddah. Bleeding caused by uterine prolapse is dam makkah, bleeding from a wound, and not dam niddah.  In other words, if it can be confirmed that the blood stems from her prolapse, it does not render her niddah or invalidate her clean days.

When a woman with a prolapse does become niddah (e.g., through menses), she will still need to obtain some clean internal examinations (hefsek taharah and bedikot) before immersion. However, in such a case the number of required examinations may be reduced in consultation with a rabbi.

There are also halachic interventions to prevent unnecessary niddah status due to stains. The physician should assure that the woman has consulted with a rabbi experienced in the area of Jewish law to make sure that all such interventions have been tried prior to undergoing surgery. Other less invasive methods such as endometrial ablation or fibroid embolization should also be considered before recommending hysterectomy for this indication.



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  Specific Gynecological Procedures
 

Endometriosis
  Fibroids
  Hormonal Cycle Manipulation
  Hormonal Cycle Manipulation for Brides
  Inter-Menstrual Bleeding
  Non Uterine Causes of Vaginal Bleeding
  Polycystic Ovarian Syndrome
  Urinary Tract Infection
  Vaginal Bleeding from Injury or Lesions