Checking for Non-Uterine Sources of Bleeding
Dam makkah, bleeding from an injury or lesion outside the uterus, does not render a woman niddah. (Authorities differ regarding the status of bleeding from an injury within the uterus.)
Bleeding from a lesion in the vaginal canal or on the outside of the cervix can result in red staining on bedikot and lead to difficulty in completing a hefsek taharah or in counting shivah neki'im. When this happens, a medical examination may be needed to identify a non-uterine source of bleeding.
In Israel, and in some larger Jewish communities, bodkot taharah are available to perform these examinations. A bodeket taharah is a woman, generally a nurse and/or midwife, specifically trained to examine women for non-uterine sources of vaginal bleeding and to report her findings to a rabbi. Where necessary, a bodeket taharah can also perform a hefsek taharah or bedikah with the aid of a speculum, confirming the absence of uterine bleeding while avoiding stains from lesions outside the uterus. Referrals to a bodeket taharah are generally available through local rabbis, or from Machon Puah. A list, in Hebrew, of bodkot taharah in Israel is available here.
Where a bodeket taharah is not available, a rabbi may recommend that a woman be examined by a specific nurse or physician who is experienced in halachic examinations. Or he may recommend she see her own physician. She should ask the doctor to report whether he observed any lesion that could bleed - even on contact, and even if it is not a pathological finding.
Click here for a form that a medical professional can use to report the findings of an examination to a rabbi. The article Vaginal Bleeding from Injury or Lesions from www.jewishwomenshealth.org (our sister site for medical professionals) may also be helpful in explaining to a physician the halachic significance of the examination. Patients may print the form and/or article and bring them to the appointment.