Abstract: The bleeding that may accompany the stretching of the hymen with the onset of intercourse renders a woman niddah by rabbinic decree. This is a frequent source of medical questions for newly married couples.

Discussion: Bleeding that may accompany the stretching of the hymen with intercourse is not of uterine origin. Nevertheless, it renders a woman niddah by rabbinic decree. Furthermore, the first time a woman has intercourse with full penile penetration, she is niddah even if no bleeding is observed. If there is partial penetration without bleeding, the status is a matter of rabbinic debate and the couple should consult with their rabbi as to how to proceed.

The wife may come to the doctor to determine whether the hymen has been broken or stretched. The physician should report his or her findings to her so that she can convey them to her rabbi for adjudication. If she bleeds on subsequent occasions from the hymen, she may become niddah again. In this case it is likely that the couple will request that the physician remove the remnants of the hymen. Medical removal of the hymen (as in the case of imperforate hymen) does not render a woman niddah according to most rabbinic authorities. However, it should be remembered that bleeding from the procedure or resulting poor healing may complicate the ability of a woman who is already niddah to perform the needed self examinations. Therefore, with the exception of clear cut cases such as an anomalous hymen that is preventing penetration, the benefits and risks should be carefully weighed before the procedure is performed.

Implications for care: As bleeding from the hymen renders a woman niddah, women may turn to their physician to determine whether the hymen is still present or not.

They may also ask questions about hymenal removal.

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