A.

Teliah b'makah attributing bleeding to an injury

The status of a niddah is brought about only by menstrual bleeding. Other bleeding, even if it exits the body through the vagina, will not render a woman a niddah. Lacerations, ulcerations, inflammations (e.g., cervicitis or vaginitis) and cervical erosion are examples of such bleeding. Thus, if it can be established that vaginal bleeding is caused by an injury to the vulva, vagina or cervix, the woman is not a niddah. Indeed, even bleeding from the uterus, if caused by an injury to the uterine wall, rather than by bleeding from the endometrium, does not render the woman a niddah.8 However, it is very difficult to determine
stricter view. Thus, in their opinion, even an opening of the external os renders a w o m a n a niddah. See also Maadanei Yom Tov on Rosh, Niddah 10:5 8. EXTERIOR O F B O D Y INTERIOR O F B O D Y

Prozdor according to Rambam according to I other Rishonim I C-D B-G

Bern Hashinayim

Pesach Hamakor

Beis j Hachitzon

A-C B or nearby A-near B A-B/C

Noda Sidrei

B'Yehudah Taharah Sofer

C-D C-D C-D B-C B-C

between B/C close to C

Chasam

8. Shach 187:17, Toras HaShelamim 15, responsa Maharam Lublin 110, cited in Pischei Teshuvah 22. See letter from Chazon Ish, published originally in the monthly Hapardes vol. 35 no. 6, and reprinted in his biography P'er HaDor vol. 4 page 131. Chazon Ish categorizes dam makkah (which is tehorah) as blood which flows from the uterus when it is lacerated in a manner that blood would flow from any other organ when it is lacerated. However, if the uterus is merely shaken or hit and some menstrual blood is loosened and emitted, she is temei'ah. See Nishmas Avraham, Y.D. 187, p. 81, citing R' S. Z. Auerbach, that even if the blood flows from the very same blood vessels that emit menstrual blood, if the cause is a wound, the woman is tehorah. A similar position is found in Chazon Ish, Y.D. 81, s.v..

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whether blood flowing from the uterus is from an injury to the organ wall or from bleeding from the endometrium. Therefore, for all practical purposes, any gynecological procedure resulting in uterine bleeding will render a woman a niddah.9 The case to consider the woman a niddah is even stronger if the bleeding is the result of a procedure performed on the uterus close to the time of her expected menstrual period. In such a case, it is highly questionable whether the blood can be attributed solely to a wound. The possibility exists that the procedure caused her menstruation to begin early.10 If a doctor claims that the bleeding is from polyps or a uterine wound, a Rav must be consulted. A woman should never rely solely upon the information provided by a physician as a basis to consider herself tehorah. A Rav must be consulted. If a woman has a blood flow and suspects that it may be from a wound, there are several factors that must be clarified, a) A re'iyah vs. a kesem: Is she experiencing a blood flow or did she merely find a kesem on her garment or body? b) When did the re'iyah or kesem take place: at the time of her vest (her expected period, see Chapter Twelve), the thirtieth day from her last period (if she has no vest kavuah), or some other time? c) The source of the bleeding: Is the bleeding definitely from the uterus or may it be from the cervix?" d) The type of wound: Is it a wound that is certainly bleeding or a wound that may bleed?12 e) The status of the woman: Does she have a vest kavuah? f) The current stage in her menstrual cycle: Is she currently tehorah and the bleeding may render her a niddah, is she currently temei'ah and the bleeding has appeared on her hefseik taharah or bedikos, or did the bleeding occur during the first three of seven "clean" days? 1. If one can clearly establish13 that the woman has a bleeding
9. See Rambam, Hil. Issurei Biah 5:5. 10. See ruling of R' S. Z. Auerbach cited in Nishmas Avraham, Y.D. p.103. 11. If the bleeding is certainly from the uterus, we noted above that it is difficult to rule out bleeding from the endometrium. However, if the bleeding may be cervical or vaginal, there is more of a basis to consider her tehorah. 12. At times, a vaginal or cervical wound may halachically be considered a "bleeding" wound if it is prone to bleeding, although it is not bleeding at the moment. This determination must be made by a Rav. 13. Rema 187:5 is lenient even regarding a wound that is not known to be bleeding, but may be bleeding (i.e., it was not examined to see if it is bleeding and we do not know whether or not it usually bleeds), if she has a vest kavuah and is presently not at the time of her expected vest (or even if she has no vest kavuah, but never menstruates before a certain day, which has not yet arrived Chavos Daas 13[c], see Chapter Fourteen, I,D,2,d for discussion of this particular vest). Lechem VeSimlah 38[1] extends Rema's lenient rule to a nursing woman, while responsa Maharam Shick, Y.D. 181, extends it to a woman after menopause. In either case, since she is not expected to menstruate, one may attribute the bleeding to a wound, even if it is not known to bleed.

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wound14 in the vagina or cervix (whether on the inner or outer surface of the cervix) and she is currently in a tehorah state, she
One must note that the subject of the Shulchan Aruch and Rema is a woman who bleeds during cohabitation. This is a severe problem which, if not solved in some acceptable manner, may ruin her marriage. We will call this "question a." The goal of Poskim in this case is to somehow demonstrate that the bleeding is due to a wound, not cohabitation, thus permitting the couple to remain married. Another directly related issue is the question of whether the woman requires a hefseik taharah, seven "clean" days and tevilah. This pertains to any woman who finds blood which may be attributable to a wound. We will call this "question b." The case in question in Shulchan Aruch relates to both issues. Is the woman permitted to remain married and, if so, does she require tevilah? A simple reading of Rema would seem that his lenient position applies to question (b) as well as (a). Thus, any woman may attribute bleeding to a wound, even if it is not bleeding for certain, providing that she is presently not at the time of her expected vest. However, Shach 20, Toras HaShelamim 18 and Chavos Daas 6[b] contend that Rema was only lenient regarding whether she is permitted to remain married (question a), but not regarding whether to dismiss the bleeding completely without counting seven "clean" days and undergoing tevilah (question b). Shach and R' Akiva Eiger differ in their explanations of the above distinction: Shach 20 explains that we are lenient regarding question (a) only in order to save their marriage. R' Akiva Eiger (ad. loc.) contends that we are lenient regarding question (a) because it is a question of a vest (the woman seems to have a vest to bleed during every cohabitation; thus, she may not cohabit). Since we rule that vestos are deRabbanan (Rabbinic), one may be lenient. However, the question of requiring tevilah, argues R' Akiva Eiger, is deOraisa and thus is more severe. See Chazon Ish (Y.D. 82:1) who clarifies the distinction between the viewpoint of Shach and R' Akiva Eiger. Following Shach's approach, we may be lenient regarding a woman with a chronic bleeding condition and permit her without tevilah. In this case, too, her marriage is jeopardized, see Graz 23 and Aruch HaShulchan 58. Consistent with R Akiva Eiger's approach, we cannot be lenient in a case of chronic bleeding since the issue is deOraisa. As noted above, Shach, Toras HaShelamim and Chavos Daas contend that a woman who bleeds or finds blood on a bedikah cloth (case b) is temei'ah. She cannot attribute the blood to a wound unless the wound is known to be bleeding or known to be the type that usually bleeds. Noda B'Yehudah Y.D. 1:41[1] (cited in Pischei Teshuvah 27), understands that Rema is lenient even regarding case b, i.e., permitting a woman without seven "clean" days and tevilah. Nevertheless, Noda B'Yehudah himself ibid. [3J and most other Poskim do not permit one to attribute a blood flow (or a bedikah) to a wound unless the wound certainly is bleeding. See Pischei Teshuvah ibid, and Graz 23. However, Aruch HaShulchan 57 contends that one may safely follow the lenient view (" .)" One should note that this discussion pertains only to a wound that is not bleeding for certain. If the wound is certainly bleeding, all Poskim agree that one may attribute blood to the wound and dismiss it entirely. The woman requires no tevilah, providing that it is not the day of her vest or the thirtieth day since her last period. 14. See Chazon Ish, Y.D. 82:1, who defines a bleeding wound as a wound which, when touched with a cloth, will leave a stain on the cloth (even if only when the cloth is pressed against the wound. It may be that Chazon Ish was lenient in a case where it bleeds only when the cloth is pressed against the wound only in the case of a woman who bleeds during cohabitation because the pressing of the cloth replicated the situation of cohabitation. This question remains unclear). A woman who finds a bloodstain on a bedikah cloth and suspects that it is from a wound should be able to ascertain whether the wound is a bleeding wound by applying similar pressure to the area as she applies when making a bedikah. She should then consult a Rav.

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will not be rendered a niddahby any bleeding,15 by stains found on a bedikah cloth or by any kesem found on her garments.16 It is normally assumed that if the physician can see a wound that he knows usually bleeds, she is not a niddah.17 However, if the bleeding takes place during the time of her vest, it cannot be attributed to the wound unless the physician can actually see cervical or vaginal bleeding at the time.18 2. If a woman undergoes a procedure that usually causes trauma to the cervix or uterus and she felt pain,19 it may be that she is not rendered a niddah if that type of procedure normally causes bleeding. Indeed, a Rav may rule that the woman is tehorah even if she felt no pain if, according to his information, it is clear that this procedure usually causes bleeding.20 We
15. Even heavy bleeding (Cilyon Maharsha 187:5). 16. Rema 187:5 is lenient provided that the wound is certainly bleeding (i.e., it certainly bleeds, even if she is not certain that this flow is from that wound Shach 24). He differentiates between: a) an actual blood flow (or blood found on a bedikah cloth) and a kesem. b) between bleeding found at the time that her period is not expected and bleeding found at a time that her period is expected. The various Italachos are as follows: a) If she has no vest kavuah, she may attribute the flow to the wound provided that the bleeding does not take place on the thirtieth day (or after the thirtieth day Chavos Daas 187:10[b]) from her last period. If she has a vest kavuah, she can attribute the blood to a Weeding wound, providing that the bleeding does not take place on the actual day of her vest, b) If the bleeding takes place on the day of her vest or on (or after) the thirtieth day (if she has no vest kavuah), she cannot attribute the blood to the wound even if the wound is a type that is known to bleed unless she knows that the flow is from the wound (Shach 26, Aruch HaShulchan 57). c) If she had no blood flow but merely found a kesem (even the size of a gris on a white garment), Rema is lenient in any case, even if the wound is not presently bleeding and even if the kesem is found on the day of her vest (Shach 27). Taz 10 expands upon the concept of a bleeding wound. He adds that she may attribute the blood even to a wound that is not certainly bleeding under any of the following circumstances: i) She does several internal examinations (bedikos) and always finds blood in the same spot (as in Y.D. 187:7), ii) if, at the time of the bleeding, she experiences pain (see also Pischei Teshuvah 27), or iii) if other women who have a similar wound usually bleed. In each of these cases, it is considered as if she knows the wound is bleeding. 17. The cautious tone of this statement is due to the fact that the issue of relying upon the physician in a case based on medical generalities and theories without visual evidence has not been resolved with certainty. See below Section B. 18. As in Shach 26, see Shiurei Sheivet HaLeivi (ad 10c. s.v..( 19. The presence of pain indicates that the wound is bleeding. However, Poskim are reluctant to rely upon the mere presence of pain to indicate that there is a wound present. See Beis Shlomo Y.D. 2:28 and Aruch HaShulchan 187:62. 20. Based on Taz 10, cited above.

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will not be rendered a niddah by any bleeding/ 5 by stains found on a bedikah cloth or by any kesem found on her garments.16 It is normally assumed that if the physician can see a wound that he knows usually bleeds, she is not a niddah.17 However, if the bleeding takes place during the time of her vest, it cannot be attributed to the wound unless the physician can actually see cervical or vaginal bleeding at the time.18 2. If a woman undergoes a procedure that usually causes trauma to the cervix or uterus and she felt pain,19 it may be that she is not rendered a niddah if that type of procedure normally causes bleeding. Indeed, a Rav may rule that the woman is tehorah even if she felt no pain if, according to his information, it is clear that this procedure usually causes bleeding.20 We
15. Even heavy bleeding (Gilyon Maharsha 187:5). 16. Rema 187:5 is lenient provided that the wound is certainly bleeding (i.e., it certainly bleeds, even if she is not certain that this flow is from that wound Shach 24). He differentiates between: a) an actual blood flow (or blood found on a bedikah cloth) and a kesem. b) between bleeding found at the time that her period is not expected and bleeding found at a time that her period is expected. The various halachos are as follows: a) If she has no vest kavuah, she may attribute the flow to the wound provided that the bleeding does not take place on the thirtieth day (or after the thirtieth day Chavos Daas 187:10[b]) from her last period. If she has a vest kavuah, she can attribute the blood to a bleeding wound, providing that the bleeding does not take place on the actual day of her vest, b) If the bleeding takes place on the day of her vest or on (or after) the thirtieth day (if she has no vest kavuah), she cannot attribute the blood to the wound even if the wound is a type that is known to bleed unless she knows that the flow is from the wound (Shach 26, Aruch HaShulchan 57). c) If she had no blood flow but merely found a kesem (even the size of a gris on a white garment), Rema is lenient in any case, even if the wound is not presently bleeding and even if the kesem is found on the day of her vest (Shach 27). Taz 10 expands upon the concept of a bleeding wound. He adds that she may attribute the blood even to a wound that is not certainly bleeding under any of the following circumstances: i) She does several internal examinations (bedikos) and always finds blood in the same spot (as in Y.D. 187:7), ii) if, at the time of the bleeding, she experiences pain (see also Pischei Teshuvah 27), or iii) if other women who have a similar wound usually bleed. In each of these cases, it is considered as if she knows the wound is bleeding. 17. The cautious tone of this statement is due to the fact that the issue of relying upon the physician in a case based on medical generalities and theories without visual evidence has not been resolved with certainty. See below Section B. 18. As in Shach 26, see Shiurei Sheivet HaLeivi (ad loc. s.v..( 19. The presence of pain indicates that the wound is bleeding. However, Poskim are reluctant to rely upon the mere presence of pain to indicate that there is a wound present. See Beis Shlomo Y.D. 2:28 and Aruch HaShulchan 187:62. 20. Based on Taz 10, cited above.

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emphasize again that under no circumstances should one reach such conclusions without Rabbinic guidance. 3. If the procedure was done on the day21 of her vest kavuah22 day or on the thirtieth day from her last period (if she has no vest kavuah), one cannot attribute the blood to the wound unless the physician actually sees the blood flowing from the wound. 23 4. If no actual bleeding was noticed and no blood was found on a bedikah cloth, but the woman found a bloodstain on her undergarments, the question involves only a kesem, which is less serious. Poskim rule that the kesem may be attributed to the wound even if the wound is not presently bleeding24 and even if we are not aware of the tendency of this type of wound to bleed.25 This is true even if the kesem is found on the day of her expected period26 and even if the wound is partially healed if it is still prone to bleed when irritated.27 5. One should note that this discussion pertains to a woman who finds a blood flow or a stain during the time period in which she is tehorah. The stain is attributed to the wound and is ignored. Similarly, a bedikah may be ignored under such circumstances if the wound is known to be bleeding.28 However, a woman who must establish a status change through a bedikah cannot rely on a bedikah with a stain, even if the stain may be attributed to another source. While we can ignore the negative effect of the stain by attributing it to a wound, we cannot use the bedikah in a positive manner, i.e., to prove that there is no longer any bleeding from the uterus. Thus, a woman with a wound who must do a hefseik taharah and start
21. Shiurei Sheivet HaLeivi 187:5[4] is uncertain regarding bleeding from a wound during the twelve-hour period before the actual vest (commonly called "the Or Zarua onah"). 22. However, one may attribute bleeding to a wound on the day of vest she'aino kavuah (Chezkas Taharah 187:68). 23. Shach 26, Aruch HaShulchan 57. See Chavos Daas 10 [b] who maintains that once the thirtieth day passes she can no longer attribute blood to the wound. 24. Rema 187:5. 25. Shach 27. 26. Rema and Shach ibid. 27.190:18. 28. See Shach 187:19 and Pischei Teshuvah 24.

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the seven "clean" days is faced with a serious problem. The hefseik taharah must be tahor beyond any doubt. Even if the blood on the cloth is attributable to a bleeding wound, it is essentially as if the hefseik taharah was not performed. Indeed, even the validity of the first bedikah of the seven "clean" days is questioned by Poskim if blood is found on the cloth, though the blood is attributable to a wound. 29 A woman who finds it difficult to do these bedikos should consult a Rav. 6. If blood is found during the first three of the seven "clean" days, it is more difficult to attribute it to a wound since, during this period, we suspect that any bleeding may be a continuation of her menstrual flow. Poskim discuss the various conditions under which one may attribute blood to a wound even during those three days (see footnote).30 It is therefore advisable that if a woman must have a procedure done during the seven "clean" days, it should preferably be delayed at least until after the first three days.31 A woman who must undergo a medical procedure during the seven "clean" days should consult with a Rav whether or not she should do all of the normally required bedikos and whether she should wear white or colored garments during those days. A Rav may advise her to do only one bedikah on the first and one on the seventh of the seven "clean" days. Depending upon the circumstances, he may advise that she wear colored garments.
29. Chavos Daas 196:3 and responsa Avnei Miluim, end of 23, rule that at least one bedikah of the seven "clean" days must be free of any blood. Chasam Sofer, Y.D. 177, rules that in a case of extreme necessity, one may be lenient with the bedikah of the seven "clean" days provided that the hefseik taharah was clean and free of any bloodstain. Shiurei Sheivet HaLeivi 187:5[3] rules that one should not be lenient. Igros Moshe, O.C. 3:100, is also strict regarding the hefseik taharah and the bedikah of the first day. Some Poskim differentiate between a case where the hefseik taharah is required after a normal menstruation and a case where the hefseik taharah is required after she was rendered a niddah by a flow on her vest day which may have actually come from the wound. See Taharas HaBayis vol. 1 page 252. 30. Regarding a kesem, see Chapter Eleven, note 103. Regarding blood found upon a bedikah cloth, responsa R' Akiva Eiger 78 rules that the stain cannot be attributed to the wound even if she has a vest kavuah and the bedikah was not done on the vest day. Shiurei Sheivet HaLeivi 196:10[7] rules that if the woman can ascertain that the blood was from the wound, i.e., she always finds blood on the same spot, she is tehorah. Igros Moshe, Y.D. 1:95, is lenient if the physician inserted an instrument and claims that the bleeding is caused by trauma of the instrument. It is unclear if Igros Moshe is referring to a kesem or even to a blood flow. This refers to a woman who happened to find blood on a bedikah cloth. However, if she has a chronic condition, Poskim are lenient even regarding the first of the seven "clean" days. 31. Igros Moshe, Y.D. 1:83, O.C. 3:100.

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One should not take any of these steps without Rabbinic approval. 7. A woman who finds a bloodstain on a bedikah cloth, notices that she consistently finds the stain on a particular spot and suspects that it is due to a vaginal wound, should consult a Rav.32

B. Ne'emanus halachic acceptability of

a doctor's claim
There is much discussion in halachic literature33 regarding the issue of whether one may rely upon a physician in matters pertaining to halachah.34 The question is twofold:
32. See 187:7. Poskim disagree whether Shulchan Aruch, in this case, is referring to a woman who is aware of a wound in the vagina. In the opinion of responsa Noda B'Yehudah 1:46 (cited in Pischei Teshuvah 37), Chavos Daas 7[b], 20[c], Chochmas Adam 110:11 and R Akiva Eiger 1:61, Shulchan Aruch is referring to a case where the woman is aware of a wound in the vagina. Otherwise, she cannot attribute the stain to a wound, even if she consistently finds the stain on the same area of the cloth. Graz 33, responsa Tzemach Tzedek, Y.D. 113, and Aruch HaShulchan 66 contend that, in the opinion of Shulchan Aruch, she may attribute the stain to a wound even if she is not aware of a wound in the vagina. The fact that she finds blood only on one spot is itself proof that she must have a wound. Among contemporary authorities, responsa Sheivet HaLeivi 5:105, Badei HaShulchan 187:118 follow the strict opinion. Taharas HaBayis vol. 1 pages 244-247, after exhaustive citation of all relevant texts, reaches a lenient conclusion. An important consideration, although not necessarily a deciding factor, is whether or not the woman experiences pain at the time of the bedikah. Some Poskim require that she test the surrounding area to establish that there is no blood in any other place in the vagina and check the suspected area three times to determine if it is actually bleeding. If blood is found in another area of the vagina, it raises the suspicion that the bleeding is from a uterine source, not from a wound. These three tests should not be performed one after another since blood found the second and third time may be residue from the earlier blood and will not prove that there is a bleeding wound (see Badei HaShulchan 116). Some Rabbonim advise the woman to see a gynecologist to ascertain whether she has a wound in the vagina. This should be done as soon as possible, since the wound that stained the cloth one day may heal by the next. The closer the examination is to the time of the bedikah, the easier it may be to determine whether the wound was there at the time of the bedikah. At times, a gynecological examination may not be a practical option. In any case, a Rav must be consulted. It is worthwhile for a Rav to know of an observant physician (preferably female) to whom he can refer women who need to be examined. 33. See Pischei Teshuvah 187:30, Darchei Teshuvah 187:98, 188:30, 194:19. See also introduction to responsa Maharam Shick, Y.D. 34. See Tur 187, Beis Yosef ibid., s.v. , who cites Sefer HaTerumos, S'mag and S'mak, who are uncertain whether one may rely even upon a Jewish physician. Ritzva (cited ibid.) is lenient only regarding an observant physician. See also responsa Shvus Yaakov 1:65.

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