Jews: Sexual Health
Judaism advocates monogamy between married couples and does not condone sex outside, or before, marriage. Opinions on homosexuality vary according to the branch of Judaism followed. Generally, sexual relations are a private matter between couples, but the discussion of sexual matters with healthcare staff is usually not a problem. Be aware of the need for sensitivity if discussing sexual health with members of the opposite gender, or with older patients, who may be reticent about such matters.
niddah during menstruation
A Jewish woman is considered to be in a state called niddah (or unclean) for the duration of her period. During this time, she may not engage in sexual relations with her husband. This state continues until she has visited the synagogue seven days after her menstrual flow has ceased; after immersion in the mikveh, she is considered clean again. This state of niddah has nothing to do with physical uncleanliness, but rather is a spiritual state; one of the key duties of a woman is to bear children, and while menstruating, she is not capable of this duty and so unclean. A Jewish woman may not be happy to have any intimate physical examination carried out during this time.
niddah after birth
The state of niddah also applies to a woman during and after the birth of her baby. Again, she will visit the synagogue to bathe in the mikveh and restore her clean status. This ritual will take place seven days after the birth of a boy and 14 days after the birth of a girl.
Traditionally Jewish law has condemned contraception when it is carried out for selfish reasons; the first commandment in the Torah compels Jews to go forth and multiply, and does not mention that this should only occur when convenient! However, contraception has recently become more acceptable, especially among Reform and Liberal communities, as long as it is part of a couple's scheme for planned pregnancies and not a total avoidance of them.
The method of contraception permitted may depend on the type of Judaism practised; Orthodox Jews prefer to rely on the rhythm method or the oral contraceptive Pill, whereas Reform Jews may also consider other methods. Condoms are generally regarded as unallowable; there is a commandment against 'killing the seed', which the use of a condom obviously breaks. However, some Liberal Jews may still use this method. It is recommended that discussion about contraception should involve both husband and wife, and any doubts be referred to a rabbi.
termination of pregnancy
Until the head of a baby has left the womb of its mother, it does not gain full status as a living person. This means that in any situation where the mother may die if the pregnancy continues, the law allows for a therapeutic abortion to save the life of the mother at the expense of the child. Of course, the situation is rarely this simple. In cases of rape, for example, where the mental health of the mother may be at risk if the pregnancy continues, opinion is split as to whether such an abortion is permissible. As with many issues, the outcome of a discussion will depend on what type of Judaism is practised by the mother, and the opinion of a rabbi and even family should be sought to help clarify matters.
Generally, the most important consideration is the future health and happiness of the family as a unit. Will this termination mean that a couple always mourn their unborn child to the detriment of any other children, or would their family be over-burdened by the addition of a new baby? Orthodox and Reform Jews may have very different opinions about this matter, and so be prepared to take a lead from the patient when discussing the possibilities. Either way, if the aborted child has 'human form', then it will need to be treated as though it were a full-term stillbirth; a rabbi and the local burial society must be contacted and a full burial planned.
Artificial insemination is permitted by all Jewish groups, provided that every other avenue leading to conception has been explored. In all cases, donor material is not permitted; the eggs and sperm used must belong to the couple concerned. It is suggested that a couple consult with their rabbi about fertility treatment before beginning the process, as they will need support and advice throughout the process.
Although masturbation is generally prohibited, it may be allowable to collect samples for fertility treatment. Discuss this with your patient; they may feel much happier carrying out this procedure at home than in a clinic.
Surrogacy is a new technology, and as such the degree of its acceptability within Jewish culture is still a matter of debate and will largely depend on the type of Judaism practised by a patient. Generally, Reform Jews will allow a surrogate pregnancy, but may insist that the eggs and sperm used are those of the couple concerned rather than donated material from an anonymous source. Surrogacy poses problems for the traditional matrilineal inheritance of Jewishness, and this is why it is condemned by more Orthodox Jewish groups. It is strongly suggested that a rabbi's opinion be sought and discussed with a couple if surrogacy is proposed.
Sterilisation for 'selfish reasons' is generally condemned. If a medical necessity can be proven, then obviously the procedure must be carried out. It may be a good idea to discuss the preservation of eggs or sperm for future needs if the sterilisation is for medical reasons, but this discussion may need to involve a rabbi, depending on the type of Judaism practised by a couple.
If a hysterectomy is a medical necessity, then it must proceed. If the woman is past child-bearing age, then there are no further religious complications, but if she has not yet had children, or wants to have more in the future, then this must be taken into account. It may be that eggs need to be extracted for preservation, and the possibility of a surrogate pregnancy discussed, but again it is strongly advised that specialised rabbinical help and advice is sought in such cases.
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