This article will guide you on what to do if you find unexpected spotting or staining and you don't have the luxury of living near a certified Bodeket.
If you find any spotting or staining, that you suspect to be of non-uterine origin, you will have to rely on your healthcare provider - your physician, midwife, etc - to determine the origin of the bleeding.
Often, Halachic wounds, which may be significant in determining your Niddah status, may be overlooked by your physician since halachic wounds are usually insignificant from a medical and/or health point of view. By asking a number of key questions you can guide your Physician to obtain the findings necessary to relate to your Rav so that he may be able to render a halachic determination (psak).
Questions to ask your physician or other healthcare provider, BEFORE the exam, so that he will be aware of what you want him/her to find out:
1. Is there any bleeding from the uterus?
2. Very important question: Is there an ectropion*? Is it bleeding? If the ectropion is not bleeding, touch it with a swab, does it bleed? If it does not bleed when touched with a swab, does it bleed when touched with a Bedika cloth? Please provide your Physician with a Bedika cloth so that he/she can touch the ectropion with the cloth. An ectropion is the most common cause of non-uterine bleeding.
3. While doing the exam do you see any lesions, cysts, erosion, polyps or any other irregularities on the cervix? Is it bleeding? If it is not bleeding, touch it with a swab, does it bleed? If it does not bleed when touched with a swab, does it bleed when touched with a Bedika cloth (please provide your physician with a Bedika cloth.)
4. While doing the exam, do you see any lesions or irregularities on the vaginal walls? Is there any bleeding from the vaginal walls? If it does not bleed, touch it with a swab, does it bleed? If it does not bleed when touched with a swab, does it bleed when touched with a Bedika cloth? The vaginal walls are not a common source of bleeding.
5. Is there any bleeding from the vulva? If there is no bleeding, touch it with a swab, does it bleed? If it does not bleed when touched with a swab, touch it with a Bedika cloth, does it bleed? Is there an episiotomy site that is not completely healed?
6. Could the exam itself lead to any spotting or bleeding? If yes, what is the source of this bleeding?
7. For how long could any of the bleeding, found during the exam, be expected to last? And can the bleeding stop and then resume when/if touched?
8. How much bleeding should you expect to be seen?
9. Should you expect the bleeding to be constant, intermittent or only when touched?
These questions are a guide to ask in the event of unexpected spotting or staining, that you suspect is non-uterine bleeding. It is NOT a guide for a routine exam or for an exam that includes a procedure. The questions asked in those situations would be somewhat different and should be asked to your Rav or Kallah teacher prior to the appointment/procedure.
Although you may not live near a certified Bodeket, the above guide will help you obtain a Halachic ruling from your Rav in the case of unexpected spotting or staining. This will, hopefully, help you get to the Mikvah on time and prevent unnecessary separation between husband and wife. If more guidance is needed, please contact mikvah@mikvah.org