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 primary types of hysterectomy. In a total hysterectomy, the entire uterus, including the cervix, is removed. In a subtotal hysterectomy only part of the uterus is removed.

Halachic permissibility of hysterectomy

Hysterectomy is a form of sterilization, which is generally considered a rabbinic prohibition for women. Nevertheless, hysterectomy is usually halachically permitted when medically indicated and there are no medically comparable alternatives that preserve fertility. Hysterectomy is even more readily permitted when a woman is no longer fertile.

Niddah after hysterectomy

Since niddah status only results from uterine bleeding, a woman who has had a total hysterectomy can no longer become niddah, regardless of whether her ovaries remain.

Following a subtotal hysterectomy, it is possible for a woman to become niddah again from residual uterine tissue. If a woman bleeds after her first post-operative immersion, an individual question should be asked.

Does the surgery make a woman niddah?

There are different methods of performing a hysterectomy. Some of them are more likely to render a woman niddah than others. In some cases, halachic authorities disagree as to whether the hysterectomy procedure renders a woman niddah.

Common practice is to rule stringently, since it is often a woman’s final time in niddah, but to omit the bracha over post-operative immersion if a woman was tehorah prior to the procedure. If this presents particular difficulty, a specific halachic question should be asked.

Becoming tehorah after the surgery

In the usual process of becoming tehorah, a woman performs a hefsek taharah and bedikot in order to check for uterine bleeding.

Following a total hysterectomy, however, there is no possibility of uterine bleeding, and thus no need for a hefsek taharah or any bedikot during the shivah neki’im. A woman merely counts seven days and immerses.

Following a subtotal hysterectomy, a woman should clarify whether it is medically possible for her to experience bleeding from residual uterine tissue.

• If it is no longer possible for her to experience uterine bleeding, then she, too, may simply count seven days and immerse, with no need for a hefsek taharah or bedikot.
• If it is still possible for her to experience uterine bleeding, then she will need to perform a hefsek taharah and bedikot. In this case, she may have difficulty navigating the clean days for a few weeks because of bleeding from the trauma of the procedure, dam makkah. To ease this process, she may omit the moch dachuk, limit her bedikot to the hefsek taharah and one each on days one and seven of the clean days, and wear colored undergarments or pantyliners during the clean days for the first post-operative cycle. If these measures are insufficient to enable a woman to get to the mikveh, she should ask a specific halachic question.

Final Immersion

A woman who has a hysterectomy before naturally entering menopause might like to give special thought to her post-operative immersion and to taking leave of the niddah cycle within her relationship. Some women find it helpful to compose personal prayers for this immersion. Couples may benefit from discussing the relationship implications for them.

When a woman is no longer in niddah, immersion is permissible without a bracha. Some women incorporate mikveh into their post-hysterectomy lives even when there is no longer an obligation to immerse.

This article was updated on 22 September 2022.