Questions Pertaining to Procreation and Sexuality

Subject: Gynecological diagnostic procedures

Question: Does a pelvic examination or pap smear or endometrial biopsy or I.U.D. insertion with or without resultant bleeding render a woman niddah?

Answer: Bleeding following a pelvic examination does not necessarily render a woman niddah.

Comment:
a) Pelvic examinations – When a gynecologist finds it necessary to perform a pelvic examination on a Jewish woman patient, any bleeding that may ensue from the physical irritation of the examination is not considered to be menstrual blood necessitating abstinence. However, if for any reason, it is necessary to pass an instrument past the cervical os into the cervical canal, the Jewish patient must be so advised. If the instrument is 0.7 inches in diameter (1.75 cm) or more, the patient must consider herself to be a niddah even if no bleeding ensues. Bleeding from cervical erosions or the cauterization used to treat these erosions is not considered niddah blood. If feasible, pelvic examination should be done within 24 hours prior to onset of menses. It is necessary for the patient to consult with her Rabbi to determine the regulations that she must observe following pelvic examinations.
b) Pap smear – In the usual procedure no instrument penetrates the cervical os. The cotton swab and wooden applicator stick are of such dimensions as to present no halachic concerns.
c) Endometrial biopsy – Although the uterine cavity is entered in endometrial biopsy, the instrument is usually less than 6 mm in diameter and therefore does not cause psichath hakever (cervical dilatation). Therefore, the patient is not considered a niddah.
d) I.U.D. insertion – The cervix is usually dilated to permit insertion of an intrauterine contraceptive device. Even if no bleeding occurs, the patient becomes a niddah.
e) Rubins or tubal patency test – Tubal air insufflation is performed to determine if the Fallopian tubes are free of blockage or adhesions. The instruments used do not present any halachic problem because the cannula used is always less than 10 mm in diameter. If the tubes are found to be patent, no halachic problem ensues. If blockage is found, the backward pressure of the carbon dioxide may be viewed by some as a "dilation" and rabbinic consultation is necessary.
f) Hysterogram – The radio-opaque dye used to infuse the uterus is administered via a cannula only a few millimeters in diameter. Thus there is no psichath hakever and the niddah state is not induced.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Contraception

Question: Under what circumstances, if any, may contraceptive methods be employed? Which methods are most preferable in Jewish law?

Answer: Contraceptive methods may be used only for specific medical or psychiatric indications.

Comment: Contraceptive devices cannot be used except for specific medical indications such as rheumatic heart disease, severe renal disease and similar situations, where pregnancy would constitute a serious threat to the health of the mother. Jewish law requires that the marital act be as normal as possible. When medical indications, which include psychological factors, necessitate the use of a contraceptive technique, Jewish law grades methods of contraceptive techniques from least to most objectionable in the following order: oral contraceptives, chemical spermicidals, diaphragms and cervical caps to be used by the wife, condoms, and coitus interruptus. The most objectionable method, and one that is least often recommended by Jewish law, is the use by the male of the condom or withdrawal.
An intra-uterine contraceptive device (I.U.C.D.) cannot be sanctioned by Jewish law until and unless there is clear evidence as to its mode of action. On the basis of the best evidence presently available, these devices act as early abortifacients. Their propensity for inducing intermenstrual spotting is also a significant deterrent to their use.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Contraceptive counsel to unmarried girls

Question: Does halacha permit the orthodox Jewish physician to give contraceptive advice to and to prescribe contraceptive devices for unmarried girls?

Answer: Except under very exceptional circumstances, Judaism considers it immoral for the physician to give contraceptive advice to an unmarried girl.

Comment: The doctor must use judicious moral judgment in this sensitive area of human relations. Judaism deems it immoral to give contraceptive counsel to unmarried persons when such advice may serve to remove an important barrier to immoral conduct. When confronted with the mentally retarded patient or with people in whom self-discipline is lacking as determined by previous conduct, consultation with a religious guide should be undertaken to decide the proper course of action.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Sperm procurement and analysis

Question: Is sperm analysis permissible in Jewish law? Under what circumstances? How should one obtain the sperm?

Answer: Sperm analysis is allowed when medically indicated, provided the sperm is obtained as described below.

Comment: During the medical work-up of a sterility problem, it is occasionally necessary to test the semen of the husband for quantity and quality of sperm. The least objectionable method is the procurement of sperm by coitus interruptus, or if this is unsatisfactory for any reason, a condom (Milex sheath) may be applied on the male membrum prior to coitus. These two procedures involve the natural sex act and are, therefore, most acceptable to Jewish law.
Masturbation to obtain sperm is strongly condemned, based upon the following Talmudic passage:
"... Rabbi Eleazer stated: Who are referred to in the Scriptural text Your hands are full of blood (Isaiah 1:15)? Those that commit masturbation with their hands. It was taught at the School of Rabbi Ishmael: Thou shalt not commit adultery (Exod. 20:13) implies that thou shalt not practice masturbation either with hand or with foot...." 
The use of a mechanical vibrator applied to the anal area to induce erection and ejaculation to procure semen for examination can also be approved, if necessary.
To have sexual intercourse in the physician's office so that the physician can retrieve the sperm from the vagina of the woman is considered licentious and improper. When it is necessary to evaluate sperm survival in the vaginal tract, a nearby hotel room must be obtained to enable the wife to present herself shortly after coitus for such testing. Of course, the laws of niddah must be observed even under these medical conditions.

Source: Shulchan Aruch, Even Ha'ezer 23:1-3

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.


 

Subject: Artificial insemination

Question: Is artificial insemination ever allowed in Jewish law? Under what circumstances? Is the ruling different depending upon whether donor sperm or the husband's sperm is used?

Answer: Under most circumstances, artificial insemination using donor sperm is not permitted. Semen from the husband may be used to impregnate his wife if no other method is possible.

Comment: Artificial insemination using the semen of a donor (A.I.D.) other than the husband is considered by most Rabbinic opinion to be strictly prohibited for a variety of reasons, including the possibility of incest, confused genealogy and the problems of inheritance. However, without a sexual act involved, the woman is not guilty of adultery, and is not prohibited to cohabit with her husband. The child born from A.I.D. does not carry any stigma of illegitimacy. The use of semen from the husband is permissible if no other method is possible for the wife to become pregnant. If the insemination must be performed during the wife's period of ritual impurity, consultation with a Rabbinic authority is indicated.
Since many important legal and moral considerations which cannot be enunciated in the presentation of these general principles may weigh heavily upon the verdict in any given situation, it is essential that each individual case be submitted to Rabbinic judgment which, in turn, will be based upon expert medical opinion, both physiological and psychological.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Induction of labor

Question: Is there a halachic objection to inducing labor by means of oxytocin or prostaglandins?

Answer and Comment: If induction of labor is undertaken for clinical indications of major obstetric complications, that is to say the welfare of the mother or child, it is certainly permissible. Such situations might include severe pre-eclampsia, diabetes mellitus, bleeding, overdue babies, blood group incompatibility, or the like, according to the judgment of the obstetrician.
Any medical or surgical procedure which is carried out for any purpose other than the benefit of the patient constitutes assault and battery. Hence, induction of labor undertaken for the social convenience of the mother and/or obstetrician is contrary to halacha. Halacha clearly forbids any procedure that carries additional risk to mother or child. Induction of labor for social convenience may well involve increased risk to the baby or mother and, hence, would constitute an unethical procedure in the eyes of Jewish law.
The following is a quotation from an editorial in the prestigious medical journal Lancet (Nov. 16, 1974, pp. 1183-4):
". . . induction on the grounds of social convenience is a pernicious practice which has no place in modern obstetrics. The mother's holiday, the calls of the obstetrician's private practice, must not influence, for the sake of even a few days, an event which for the child may affect the outcome of its entire life. Social convenience must be dismissed. Medical convenience - daylight delivery - is a more difficult problem; the argument goes as follows: The chances of the occurrence of a major life-threatening emergency are greater at delivery than at any other time of life. If one could choose the time of one's road accident, coronary thrombosis, orgastrointestinal ~aernorrhage, it would be at 10 A.M. on a Tuesday in October. No-one is asleep, on holiday, or a dozen miles away. Obstetric complications offer, in principle, a similar choice: a median delivery-time of 5 P.M. on a weekday could be achieved for at least half the population. Should this be the aim? The question cannot be easily answered at present.
Indeed, there is even some evidence that fetal complications, as judged by the need for incubation or oxygen administration, may be relatively more common during daylight hours.
Further observations and information are essential if an objective answer is to be found to the question whether or not induction of labor for medical convenience is sound clinical practice or meddlesome midwifery. If it really is more dangerous to be born at night, either we should make daylight delivery the norm to aim for, or we should ensure that the same facilities are available by night as during the day."

Halacha requires the latter course; namely to have all the necessary facilities available at night as well. The possibility of better response to an emergency situation during daylight hours is no justification for introducing a procedure (i.e., induction of labor) which, in itself, may be less than "good medical practice." Induction of labor should be reserved only for those clinical conditions that demand early termination of pregnancy so as to benefit mother or child.
Once labor has begun, the judgment of the obstetrician determines the need for oxytocin for the benefit of mother and/or child.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Assistance of husband during natural childbirth

Question: Is a husband permitted to assist during natural childbirth (as in the Lamaze method)? When is the wife considered a niddah or a yoledeth (parturient woman)? Is the husband's role during natural childbirth an exemption from the usual laws of niddah because of his contribution to his wife's physical and psychological welfare?

Answer: Within certain guidelines (see below) the husband is permitted to be present during natural childbirth and to provide solace and comfort to his wife.

Comment: The wife is considered a niddah or a yoledeth immediately upon the appearance of any blood, the "bloody show," mucus plug tinged with blood, or any active bleeding from the cervical canal. She is also considered to be a yoledeth if there is no bleeding at all but labor has progressed to a point of:

  1. contractions of such frequency and/or severity to make it very difficult to walk without assistance;

  2. the nurse or physicians report that the cervix is fully dilated.

Under the above conditions, the niddah state is established with all its halachic restrictions.
Prior to that time (i.e., during labor) if no blood has appeared, the woman is not a niddah and may even have physical contact with her husband. When she becomes a niddah, however, as defined above, no further physical contact is permitted.
Although the hospital environment, the presence of the medical team members, and the preoccupation of both husband and wife with the birth process minimize the halachic concern, lest physical contact lead to forbidden intimacies, it is not permitted for the husband to "wipe her face, rub her back, or support her during contraction." Indeed, proper preparations for natural childbirth should include the husband's supportive role - but without physical contact. His presence, encouragement and reassurances are the sum total of his contributions. Any physical ministrations can better be performed by hospital personnel.
In the delivery room itself, the husband should not view the act of birth of the child but should stand near the head of the table and offer encouragement and reassurance to his wife. He should not even view the birth process through the mirrors present in most delivery rooms.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Therapeutic abortion

Question: Is therapeutic abortion permitted in Jewish law? If yes, under what circumstances? Is abortion on demand allowed?

Answer: Jewish law sanctions abortions only where a grave hazard to the mother's physical or mental health exists.

Comment: Abortion on demand is prohibited by Jewish law. Jewish law sanctions abortion only when continuation of pregnancy constitutes a grave hazard to the mother. Such hazards include psychiatric disturbances that may be caused or aggravated by the continued pregnancy, if these disturbances are genuinely feared to lead to risk to life. For example, if a woman seriously threatens suicide, and if competent psychiatric opinion agrees with the possibility of danger to the woman's life, then an abortion not only may but must be carried out to save the mother, since her life takes precedence over that of her unborn child. A serious medical threat to the mother's life such as advanced rheumatic heart disease or serious kidney malfunctioning also constitutes an indication for abortion permitted by Jewish law.
The fear that a child might be born physically malformed or mentally deficient, such as following exposure to rubella early in pregnancy or ingestion of thalidomide, does not in itself justify recourse to abortion. Both before and after birth, art abnormal child (physically or mentally) enjoys the same title to life as a healthy child. This consideration is quite apart from the chance that an abortion might eliminate a perfectly normal child. The sole indication for terminating a pregnancy in Jewish law is a threat to the mother's physical or mental health that endangers her life.
Since many important Jewish legal and moral considerations which cannot be spelled out in the presentation of general principles may weigh upon the verdict in any given case, it is essential to submit every case to Rabbinic judgment.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Assisting at or performing an abortion on a Jewish or non-Jewish woman

Question: May a nurse or anesthesiologist or some other person assist in the performance of an abortion? If they may, under what circumstances? What of a non-Jewish woman who requests an abortion?

Answer: Jewish law sanctions abortions only where a serious hazard exists to the mother's physical or mental health.

Comment: In a previous Halacha Bulletin, we pointed out that abortion on demand is prohibited. Jewish law sanctions abortion only when continuation of pregnancy constitutes a grave hazard to the mother. Such hazards include psychiatric disturbances that may be caused or aggravated by the continued pregnancy, if these disturbances are genuinely feared to lead to suicide. For example, if a woman seriously threatens suicide, and if competent psychiatric opinion agrees with the possibility of danger to the woman's life, then an abortion must be carried out to save the mother, since her life takes precedence over that of her unborn child. A serious medical threat to the mother's life such as advanced rheumatic heart disease or serious kidney malfunctioning also constitutes an indication for abortion permitted by Jewish law.
The fear that a child might be born physically malformed or mentally deficient such as following exposure to rubella early in pregnancy or ingestion of a teratogenic drug does not in itself justify recourse to abortion. Both before and after birth, an abnormal child (physically or mentally) enjoys the same title to life as a healthy child. This consideration is quite apart from the chance that an abortion might eliminate a perfectly normal child. The sole indication for terminating a pregnancy in Jewish law is a threat to the mother's physical or mental health so that her life is in danger.
Request for abortion by Jewess or non-Jewess in no way removes the prohibitions involved. Neither the obstetrician-gynecologist or anesthesiologist or nurse nor any other person may perform or assist in any manner in such abortions unless the lifesaving considerations for the mother warrant a halachically approved abortion. The prohibition of performing abortion is a Noachian law and is therefore equally applicable to non-Jewish physicians, based on the scriptural verse whoso sheddeth the blood of man in man, his blood shall be shed (Genesis 9:6).

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Research on aborted fetuses

Question: Is it permissible to perform medical research on a spontaneously or therapeutically aborted fetus? If the fetus is alive? If the fetus is dead?

Answer: No, if the fetus is alive; yes if the fetus is dead.

Comment: If the fetus is alive, although not viable because of prematurity or malformation, it is considered to be a living person in all respects. Any research activities that might shorten the life of this fetus are absolutely prohibited.
If the abortus is dead as defined by halachic criteria, viz. absence of respiration and absence of cardiovascular pulsations, then there does not exist any Biblical requirement for burial. However, it is desirable to secure the fetus for burial, in order to preserve the dignity of man "created in God's image" and the sanctity of the dead. Since there is no absolute halachic requirement for burial, for cogent and critical medical research a dead fetus may be used without halachic objection.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Sterilization

Question: Is sterilization of a man or a woman permissible in Jewish law? Is ligation of the vas deferens during prostatectomy permissible? Is oophorectomy or orchiectomy for malignant disease allowed?

Answer: Only in cases of absolute medical need is a sterilizing procedure (ligation of Fallopian tubes or vas deferens) or ablative sterilization by surgical or medical (radiation or drugs) means permissible.

Comment: Surgical or physical impairment of the reproductive organs of any living creature violates Jewish law, except in cases of urgent medical necessity. In the case of males upon whom the Biblical commandment of be fruitful and multiply rests, only a risk to life can justify such procedures: hence, unless medically demanded, the ligation of the vas deferens during prostatectomy should be avoided. The prohibition against impairing the male reproductive organs and functions is unrelated to man's fertility. It applies even to a man known to be sterile or impotent, whether by reason of age or physiological aberration.
The sterilization of females is permitted when medically imperative. Rabbinic opinion, as well as the consent of the husband, should always be secured prior to considering ligation of the Fallopian tubes or other surgical procedure leading to sterility. Contraceptive techniques such as diaphragm with spermicidals should be evaluated before the decision to intervene surgically is made.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Vasectomy and/or orchiectomy

Question: Is it permitted to perform a vasectomy or orchiectomy or in any other way castrate or sterilize a male?

Answer: Only in cases of absolute medical need is vasectomy or orchiectomy permitted.

Comment: It is prohibited in Jewish law to render a male human or animal sterile. This halacha makes it difficult for a Jew to practice as a veterinarian since the castration and spaying of animals is a major part of urban veterinary practice.
Only in cases of urgent medical need (e.g., cancer) where a risk to life exists, is such a procedure permissible. Hence, unless medically essential, the ligation of the vas deferens during prostatectomy should be avoided. The prohibition against impairing the male reproductive organs and functions is unrelated to man's fertility. It applies even to a man known to be sterile or impotent, whether by reason of age, or of anatomic or physiologic aberration that have occurred after birth.
Vasectomy as a "population control" technique is not condoned in halacha. It is forbidden to assist at such surgery in any way on man or animal.
The halachic evaluation of new experimental techniques, such as gold valves and silicon plugs, and the impact of "reversible vasectomies" by virtue of new surgical procedures, is not yet complete. The initial opinion is that they cannot be condoned, but more study is needed. The imbibition of a sterilizing potion by a male (hormonal or cytotoxic) is prohibited, and the physician may not prescribe such a medication for men.

Source: Karo's Shulchan Aruch, Even Ha'ezer #5:11-13

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Tubal ligation, hysterectomy and oophorectomy

Question: Under what circumstances, if any, is it permitted to sterilize a woman or female animal?

Answer: Sterilization of females is permitted in Jewish law when medically imperative.

Comment: In a previous Halacha Bulletin, we pointed out that in Jewish law it is prohibited to surgically, radio-therapeutically, physically or medically impair the reproductive organs of any living creature, male or female; human, animal, fowl or beast.
Although the Biblical commandment to be fruitful and multiply rests primarily on the male, sterilization of females is only permitted for specific medical indications.
Veterinary medicine is thus not a desirable profession for an orthodox Jew because much of the day to day practice consists of spaying and castration of animals, acts prohibited in Jewish law.

Source: Karo's Shulchan Aruch, Even Ha'ezer #5:11-13 and the commentary of the Vilna Gaon there in subsection 25

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Medical management of infants with ambiguous genitalia

Question: How does one halachically approach a child with ambiguous genitalia? Do psychological considerations play a role in the decision to "make" the child into a boy or a girl?

Answer and Comment: The sex determination of an infant or child with ambiguous genitalia must be based on cytological and genetic (i.e., medical) evidence, not on psychological considerations. The presence of testes is to be considered an absolute sign of maleness.
A genetically male infant must not be surgically modified to permit rearing him as a female. His inability to function as the male partner in marital relations is not adequate justification for such a sex change. In true hermaphroditism, or when no clearly differentiated gonad is evident, the decision as to the sex identity of the child must be arrived at by careful consultation with competent medical and Rabbinic authorities.

Source: Rashi in Chagigah 4a, s.v. heshebeitzirri mibachutz

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

 


Subject: Sex change in adults

Question: Is an adult Jew (male or female) allowed to undergo a medical and/or surgical sex change? Would a woman who becomes a man be obligated to fulfill the precepts incumbent upon a man?

Answer: Jewish law prohibits sex change operations.

Comment: Surgical procedures or medical intervention (i.e., hormonal therapy) to effect a sex change in an adult is strictly forbidden for a variety of reasons, including the prohibitions of castration (sirus) and homosexuality (mishhav zachar).
Surgery, not recognized as necessary for correction of anatomic or physiological abnormalities, is viewed as an act of mutilation. The psychological stresses that underlie the patient's request for such self-mutilation must be dealt with by psychiatric therapy, not surgery.
If in violation of Torah law such a sex change operation was performed, the individual maintains his pre-surgical sex with all its halachic implications.

This Halacha Bulletin was written by Fred Rosner, MD, FACP and Rabbi Moshe D. Tendler, PhD and reviewed by HaRav Moshe Feinstein, zt"l.

© 2018 Association of Orthodox Jewish Scientists

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