Abstract: Vaginal or uterine bleeding due to trauma  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 a woman is experiencing, this is important information for her to relay to her halachic advisor.
Bleeding from injury or a lesion is referred to in Jewish law 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 . 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 may 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.
 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.
 Casey PM1, Long ME, Marnach ML. Abnormal cervical appearance: what to do, when to worry? Mayo Clin Proc. 2011;86:147-50
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