Hysterectomy


Hysterectomy

A hysterectomy is the surgical removal of the uterus. At times it is combined with an oopherectomy, in which the ovaries are removed.

There are two types of hysterectomy. In a total hysterectomy, the entire uterus, including the cervix, is removed. Since the niddah status results from uterine bleeding only, a woman can no longer become niddah following a total hysterectomy, regardless of whether her ovaries remain.

In a subtotal hysterectomy only part of the uterus is removed. It may be possible for a woman to become niddah again following this procedure. She should discuss her operative report with a rabbi to determine whether future bleeding might make her niddah.

Does a hysterectomy make a woman niddah?

There is dispute among halachic authorities as to whether a hysterectomy renders a woman niddah. An individual question should be asked.

Spotting immediately following a hysterectomy is generally from trauma to the vaginal wall, not from the uterus. Therefore, it does not render a woman niddah.

Becoming tehorah after a hysterectomy

A woman who becomes niddah as a result of a hysterectomy, or who was already niddah before the surgery, will need to count seven clean days and immerse in the mikveh. In the case of a total hysterectomy, there is no possibility of uterine bleeding and thus she does not need to perform a hefsek taharah or any bedikot. She merely counts seven days and immerses.

In the case of a subtotal hysterectomy, a specific halachic question should be asked. If it is still possible for her to experience uterine bleeding, she will need to perform a hefsek taharah and at least a minimal number of bedikot during the clean days. This may not be possible for several weeks. Although the vaginal bleeding that follows a hysterectomy can be considered dam makkah and does not render her niddah, it will impede the bedikot of the seven clean days.

In light of the difficulty in completing the seven clean days, and the fact that almost all her bleeding is likely to not be from the uterus, she may modify the taharah process as follows to prepare for the first post-operative mikveh immersion: She performs the hefsek taharah examination, omitting the moch dachuk. She then counts seven clean days, but she does not wear white underwear, and she does only two bedikot: one on day 1 and one on day 7. (It is essential to remember the bedikah on day 7. If it is omitted, she will need to restart the clean days.) She then immerses in the mikveh.

In the case of a total hysterectomy, she can never become niddah again. In the case of a subtotal hysterectomy, if she bleeds after her first post-operative immersion, an individual question should be asked.

A woman who was tehorah before a hysterectomy should still count seven days after the procedure and immerse one final time in the mikveh. She does not perform a hefsek taharah or any bedikot, and does not recite a bracha on the immersion. If this presents particular difficulty, a specific halachic question should be asked.

Permissibility of hysterectomy

There is a halachic concern about hysterectomy because it is a form of sterilization, which is generally considered a rabbinic prohibition for women. There is also halachic caution regarding any elective surgery. Nevertheless, when medically indicated, particularly if a woman is no longer fertile, hysterectomy is halachically permitted.

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