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Mikveh Immersion in the Immunocompromised Host

Abstract: There is a legitimate concern about infection in women undergoing chemotherapy. However, arrangements can be made in most mikvaot (ritual baths) to assure that the risk is quite minimal.

Discussion: There is a legitimate concern about infection in women undergoing chemotherapy [1]. For this reason, many physicians  recommend against swimming in public places. Fear of infection may also lead them to question mikveh use [2] [3]. It is very important to be aware that arrangements can be made to minimize the risk of infection. The mikveh water can be drained, and the mikveh pool cleaned with a disinfectant such as bleach and refilled with clean new tap water. The woman at risk can be the first to immerse that night. With these precautions, the risk of infection from mikveh immersion is probably less than that from bathing at home.

The preparation rooms in the mikveh present a higher risk of transmitting infection. However, it is perfectly valid for a woman to do all her preparations at home. Most women who prepare at home take a short shower at the mikveh. However, a woman for whom infection is a more serious concern can simply rewet herself in the mikveh water (prepared as described above) before she actually immerses.

It must be remembered that prohibiting a woman to immerse precludes all physical contact with her husband (not only sexual relations) if she becomes niddah. Thus, one should resort to prohibiting immersion only when absolutely medically necessary.

Implications for Patient Care: A woman who cannot immerse when she needs to is precluded from all physical contact with her husband. Therefore, a physician should assist his patient to immerse in the mikveh. Most mikvaot will be happy to accommodate special arrangements. By speaking directly to the person in charge of mikvah maintenance, the physician can assure that all medical concerns are met.

Medical References

[1] DeVita VT, Hellman S, Rosenberg SA, eds. Cancer, Principles and Practice of Oncology, Seventh Edition. Philadelphia: Lippincott Williams and Wilkins, 2005:2461-541.

[2] Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients. MMWR Recomm Rep 2000 Oct;49(RR-10):1-125, CE1-7.

[3] Leoni E, Legnani P, Mucci MT, Pirani R. Prevalence of mycobacteria in a swimming pool environment. J Appl Microbiol 1999 Nov;87(5):683-8.


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