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

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Dam Makkah (Bleeding from a Non-Niddah Source)

Dam makkah, bleeding due to a wound or lesion, does not render a woman niddah.

A woman can become niddah only with hormonal uterine bleeding, whether her menstrual period, withdrawal bleeding with hormonal contraceptives, or irregular bleeding during perimenopause, etc.

In contrast, bleeding due to a wound or lesion does not render a woman niddah. The halachic term for such bleeding is dam makkah (lit., blood from a wound). Dam makkah does not make a woman niddah, regardless of the color of the discharge or how it was found.

Any bleeding that originates outside the uterus (e.g., from the vaginal wall or the outside of the cervix) is considered dam makkah. (There is one specific exception to this rule. Due to a rabbinic decree, hymenal bleeding, dam betulim, renders a woman niddah the first time she has intercourse. Learn more here.)

Bleeding from a wound inside the uterus may sometimes also be considered dam makkah.

Bleeding from Uterine Trauma

The fundamental halacha is that blood from a wound does not render a woman niddah even if it comes from inside the uterus or inner cervix. Some authorities may nevertheless be stringent regarding bleeding from the uterus, even if a clear source of injury is seen. Other authorities may extend this stringency to the inner cervix as well, treating it like the uterus.

We follow the approach that bleeding from an injury inside the uterus or inner cervix does not automatically render a woman niddah, and that practical rulings depend on the specific circumstances.

Known trauma to the uterus is generally the result of a gynecological procedure, such as an endometrial biopsy or the removal of a uterine polyp. Following any procedure inside the uterus, a woman should ask her physician whether she should expect bleeding, and if so, what is the source of the bleeding and how long it is expected to continue. She should then ask a specific halachic question.

A medical condition that leads to bleeding in the uterus, such as a fibroid or polyp is usually not treated as dam makkah. A specific question should be asked.

Identifying Non-Uterine Sources of Bleeding

For a woman to attribute bleeding or staining to dam makkah, she must be able to establish clearly the existence of an injury, abrasion, or irritation to which her bleeding can be attributed.

A woman may be able to identify a non-uterine source of bleeding by herself on visual inspection (as with an angled mirror), or by finding blood consistently coming from a specific spot. For example, this may show on bedikah cloths or tissues.
If the source of bleeding is unclear, then discussion with a halachic authority can help determine whether bleeding can be attributed to dam makkah. Factors that may be relevant include:

  • Pain or physical discomfort
  • Bedikot that repeatedly turn up bleeding in exactly the same spot on cloths
  • Blood that looks strikingly different in shape or color from her usual uterine bleeding
  • A diagnosis for a condition sometimes associated with bleeding, such as a urinary tract infection (UTI), yeast infection, or vaginal dryness
  • A woman’s menstrual pattern and where she is in her cycle
  • Whether she is taking hormones that may cause irregular bleeding
  • Whether she is mesuleket damim (not expected to menstruate, e.g., pregnant, breastfeeding, or postmenopausal)

In some cases, an internal examination is needed to establish that bleeding is dam makkah.

Medical Examination

A medical examination can identify non-niddah sources of bleeding, and also provides an opportunity for a woman to discuss any medical ramifications of her bleeding with a healthcare provider.

When a woman sees a physician or nurse for examination, she should ask them to report whether they observed any lesion that could bleed – even if only on contact, and even if not a pathological finding.

Click here for a form that a medical professional can use to report the findings of an examination to a halachic authority. The article Vaginal Bleeding from Injury or Lesions from the section of our site designed for medical professionals, Jewish Women’s Health, may also be helpful in explaining to a physician the halachic significance of the examination. Patients may print the form and/or article to bring to the appointment.

In addition to addressing halachic concerns, a woman with irregular bleeding should not hesitate to seek medical diagnosis and treatment.

For discussion of bleeding following a medical examination, or bleeding associated with specific gynecological conditions, please see the relevant pages under this site’s “Health and Halacha” menu.

Bodkot Taharah

In Israel, and in some larger Jewish communities, bodkot taharah are available to perform internal examinations to check for dam makkah. A bodeket taharah is a woman, generally a nurse, specifically trained to examine women for non-uterine sources of vaginal bleeding. A woman who goes to a bodeket should discuss the findings with a yoetzet halacha or rabbi in order to understand the halachic implications.

Where helpful, 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.

Nishmat does not train or certify bodkot teharah. Referrals to a bodeket taharah are generally available through local halachic authorities, or from Machon Puah. A list, in Hebrew, of bodkot taharah in Israel is available here.

Bodkot taharah often work out of their homes and charge a fee for their services, though in Israel they may have a special arrangement with a local health clinic.
Where a bodeket taharah is not available, a halachic authority may recommend that a woman go to a specific nurse (sometimes called a “niddah nurse”) or physician who is experienced in halachic examinations.

Please note that an examination performed by a bodeket taharah (or similarly trained professional) for halachic purposes is meant to assist women in determining whether unusual bleeding affects staying or becoming tehorah. This type of examination can provide helpful medical information, but does not replace medical guidance, diagnosis, or treatment from a woman’s healthcare providers.

Becoming Tehorah with Dam Makkah

Since dam makkah doesn’t make a woman niddah, a woman who is tehorah and has a known makkah may fully disregard any bleeding consistent with her makkah until she reaches her veset days. She should consult a halachic authority regarding how to observe her vesatot, taking into account her specific makkah.

Dam makkah also does not invalidate the clean days. However, it can cause staining on bedikot and lead to difficulty in completing a hefsek taharah or in counting shivah neki’im.

A woman who has established that she has bleeding from dam makkah should ideally ask a specific halachic question before attempting a hefsek taharah, in order to determine how best to perform her bedikot, how many bedikot should be attempted, whether she should wear white undergarments during the seven clean days, and whether stained bedikot need to be brought for evaluation.

In general, she will need an acceptable hefsek taharah, one acceptable bedikah on day one, and one acceptable bedikah on day seven. In some circumstances, a physician or bodeket taharah (see above) may be able to assist her in performing these bedikot.

For a woman with a known makkah, stains on other bedikot, or on underwear or other surfaces, may generally be disregarded and do not invalidate her clean days. Ashkenazi rulings in this regard may be more stringent during the first three clean days.

This page was updated on 31 January, 2024.

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All health and health-related information contained within Nishmat's Women's Health & Halacha Web site is intended to be general in nature and should not be used as a substitute for consulting with your health care professional. The advice is intended to offer a basis for individuals to discuss their medical condition with their health care provider but not individual advice. Although every effort is made to ensure that the material within Nishmat's Women's Health & Halacha Web site is accurate and timely, it is provided for the convenience of the Web site user but should not be considered official. Advice for actual medical practice should be obtained from a licensed health care professional.

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