Abstract: Prior to immersion in a mikveh, a woman must remove any item that is considered a halachic barrier to immersion (chatzitzah). Medical devices can at times be considered barriers and preclude a woman from using the mikveh. This can lead to a prolonged period of niddah, during which all physical contact between husband and wife is prohibited. At times, proper planning can reduce or avoid this problem.
In order for mikveh immersion to be valid a woman must remove all substances that might impede contact between her body and the water. Even parts of the body that will not come into actual contact with the mikveh water, such as the inside of the mouth, must be free of barriers. Therefore, application of medical devices such as casts or stitches may preclude mikveh use and prevent physical contact between husband and wife.
There are, however, halachic caveats that may allow mikveh immersion with medical devices in place. These include:
- Anything inside a body cavity is considered part of the body and thus any internal stitches or devices are not considered a barrier. When inside a body orifice, certain leniencies apply.
- If the foreign substance will be permanent, it is considered to have become part of her body and is no longer a barrier. Therefore, permanent dental fillings and implants are not problematic.
A physician about to apply a device such a stitches should consider a few questions first:
Is the barrier really needed right now? For example, just before her scheduled immersion, a woman suffers a small cut that has stopped bleeding but needs sutures - consider letting her immerse before closing the lesion.
Can the item be removed without harm? If so, this is the best option. Therefore, if particular stitches are generally left in for 8-10 days, the woman is scheduled to immerse on day 7, and the wound is clearly healed - consider removing the stitches.
If the above is not possible, an individual question should be asked, as additional halachic caveats may apply.
- If the item is meant to be in place for an extended period of time,
- If the device can only be removed by a professional, or
- If the item is meant to disappear on its own (e.g., absorbable sutures)
With any of these conditions, the item may be considered "permanent" for halachic purposes. Halachic authorities differ in their rulings on the details of these situations; hence the need for an individual question. However, these caveats can be used, at times, to permit immersion with a medical device in place.A common medical concern is that the item could be damaged by water. Even if the item itself is not considered a barrier, a protective device (e.g., a plastic bag placed over the item to keep it dry) might be a barrier. It is important to realize that a woman immersing in the mikveh remains under water for less than a minute. Even if her usual custom involves multiple dunks, in this case she can certainly limit herself to the minimum, brief, one-time immersion required by halacha. Thus, decisions about protecting the item from water should reflect a situation which is much closer to a quick shower than to swimming.
Implications for practice: Medical devices may preclude mikveh use and lead to prolonged physical separation between husband and wife. Advance planning as to timing or the device used may minimize this infringement of quality of life in many cases.
In general, a cast is considered a barrier to immersion because it prevents the mikveh waters from reaching the enclosed part of the body. Plaster casts are especially problematic because the woman does not want to wet the cast and is diligent in keeping it dry.
Nevertheless, there are cases when immersion with a cast may be permitted if the cast will be on for an extended period. Each situation requires individual adjudication to determine the correct course of action. The rabbi will need to know the following information from the doctor:
- How long does the cast need to be in place?
- Is it possible to remove the cast and replace it (as is done occasionally for clinical reasons)? What would be the cost of such a procedure?
- Can the cast be left under water for long enough to allow water to seep through without ruining the cast (as may be true for some fiberglass casts)?
- The rabbi will also want to ask the woman how long she will remain niddah if she cannot immerse with the cast, and whether there are any factors that make it particularly hard for her to remain niddah for a prolonged period.
The proper procedure for mikveh immersion with a colostomy bag depends on how continent the colostomy is. If the woman always needs the bag and stool may otherwise leak into the water, the bag is regarded as part of her body and not as a barrier. Therefore, she may immerse with the bag in place. If she has some control over the flow and can ensure that it will not leak during the few minutes she spends in the mikveh, then she should immerse without the bag.
Infection control issues should be discussed with the mikveh in advance. Depending on the system, it might be best for her to be the last one to use the mikveh at night, and for the water to be changed before the next day. If there is a filtration system, it is probably still best for her to be last, but it may not be necessary to change the water.
Non-absorbable sutures that will be removed in a number of days are considered a barrier, and would invalidate mikveh immersion. If such sutures must remain in place for an extended period, there may be room for leniency in some cases. Absorbable sutures, on the other hand, are usually considered to be incipient parts of the body and do not prevent mikveh use. Women may ask for exact details of the type of suture used and the length of time it will remain in place in order to relate this information to a rabbi for adjudication.