Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Bleeding and discomfort after relations

10 July, 2013

Question:

I am in menopause. I last had my period about a year ago.

I have pain (varying degrees) and discomfort every time my husband and I have relations.

Last Friday night, there was pain, which got better. But Shabbos morning I was bleeding enough to need a sanitary pad. I also had a stinging sensation. By Saturday night, 24 hours after relations, there was absolutely no bleeding or staining.

Even though my husband and I think it is a wound, we are observing niddah. Am I really a niddah? Do I have to go to mikvah?

I do not have medical insurance, so going to a doctor is problematic.


Answer:

Based on your description, it does seem likely that you have a wound and the blood you found would be considered dam makkah. However, in the case of blood found during or immediately after intercourse, or when experiencing an actual flow, confirmation of the wound is required in order to attribute it to another source.

We understand that you are not insured and going to a doctor is problematic. Do check whether your community has a medical clinic or a women's health clinic where care is available on a sliding fee scale. One alternative may be going to a bodeket taharah – a nurse trained to look for wounds. This costs significantly less than a private doctor's visit, and usually you can be examined that day or the next day. Another possibility would be going to a gynecologist on a one-time basis; if s/he sees a condition (such as a friable cervix) that would explain the bleeding, you would not be required to have visual confirmation every time you experience such bleeding – you can rely on the initial diagnosis and attribute bleeding that is accompanied by discomfort to this source.

Aside from the niddah implications, we do recommend seeing a gynecologist for two reasons. One, vaginal bleeding following intercourse may have medical implications which should be investigated. Additionally, a gynecologist or a urogynecological physical therapist can help you explore treatment options for painful intercourse. Using a lot of lubrication such as KY gel, taking care to go slowly and gently during relations, and trying different positions may help, but there are other treatment options available to help ease the discomfort.

For the future, you should wait a few minutes after intercourse before getting up and wiping yourselves. Be sure to use colored sheets, and to clean yourself with disposable tissues or wipes, or colored towels. Do not look for any bleeding, and take care to wait 15 seconds after urinating before wiping. This way you may disregard any staining (though not an actual flow), even if you do not have confirmation of a wound.

Please feel free to get back to us with any further questions.

B'Hatzlacha!


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