Jewish Women's Health

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Jewish Women's Health

Please visit www.jewishwomenshealth.org for a wide range of articles and case studies on the topic of women's health and Jewish Law. This website is designed to assist medical practitioners in providing optimal care to their observant Jewish patients.

Information to Provide
AFTER a Gynecological Examination/Procedure

The information that is important in rendering a halachic ruling is summarized in the following list of questions. This form can be printed out as a written report whose completion will minimize the chance of errors in transmission. Click here, for the printable form.

Name of procedure / type of examination: ___________

1.	According to the patient, was she niddah prior to the examination / procedure? [ ] yes [ ] no
2.	Was she experiencing bleeding prior to the examination/procedure? [ ] active bleeding [ ] spotting [ ] no bleeding
3.	Were any lesions seen on the vaginal lining that could bleed? [ ] yes [ ] no
4.	If so, would one expect constant bleeding, intermittent bleeding, or bleeding on touch only? [ ] constant bleeding [ ] intermittent bleeding [ ] bleeding on touch only
5.	Were any lesions seen on the cervix that could bleed? [ ] yes [ ] no
6.	If so, would one expect constant bleeding, intermittent bleeding, or bleeding on touch only? [ ] constant bleeding [ ] intermittent bleeding [ ] bleeding on touch only
7.	If there is a need to enter the uterine cavity, what was the diameter of the instrument that entered the cervical canal? __________ mm.
8	Was a tenaculum was used? [ ] yes [ ] no
9.	Could the examination or procedure itself lead to any spotting or bleeding? [ ] yes [ ] no
10.	If so, what is/are the likely source(s) of the bleeding? [ ] vaginal wall [ ] outside of cervix [ ] cervical canal [ ] uterus
11.	For how long was this bleeding expected to last? (For example, the scraping of a Pap smear may be followed by a day or so of spotting.) ______ days

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This material is intended for general information purposes only. The patient's individual circumstances should be considered when making specific treatment decisions.