Is Vaginal Sexual Intercourse Permitted during Menstruation? A Biblical (Christian) and Medical Approach

Abstract

According to the Old Testament (Provisions for clean and unclean of the Mosaic Law), a woman during menstruation or a man who has sexual relations with a menstruating woman are perceived as “unclean”. When seven days pass after the first day of menstruation, the woman is regarded as “clean” and sexual contact is permitted. The character of these Provisions, according to the New Testament and Fathers of the Christian Church, was mainly pedagogical and aimed at helping the Israelites to transcend from physical purity to purification of the soul and from the worship of stereotypes to spiritual worship. Moreover, sexual contact that occurred during menstruation was considered as prostitution. From a modern medical point of view, sexual intercourse during menstruation is normal and not perversion, but is associated, although remote, with undesirable pregnancy, the development of sexually transmitted diseases (STDs) and possible endometriosis, which affects, inter alia, the health of the reproductive tract. These Provisions were essentially hygiene rules imposed by the social and cultural circumstances of that time and were invested with religious authority. The main aims of the Lawmaker were to promote the Israelites’ health, prevent them from contracting STDs, and increase their fertility and birth of healthy offspring. The term “unclean” for each menstruating woman served this aim.

Keywords:menstruation, Old Testament, sexual intercourse, hygiene, medicine, Mosaic Law.

INTRODUCTION

Menstruation, also known as period, is a natural biological process that women undergo for a major period of their lives. It is the regular discharge of menstrual fluid through the vagina that occurs as part of a woman’s monthly menstrual cycle and usually lasts around two to seven days. Menstrual fluid contains some blood (30-50 mL of the total quantity), as well as cervical mucus, vaginal secretions, and endometrial tissue.

Almost all major religions of the world have placed restrictions on menstruating women, such as the prohibition of sexual contact (1-3). Undoubtedly, their views and rules overall have played an important role in how various societies and cultures around the world and through the centuries have perceived women, man-woman relationships, and the role of women in society as a whole.

The aim of the present article is to examine and discuss briefly the vaginal sexual intercourse during menstruation from a biblical as well as modern medical point of view.

Biblical Approach

In the third book of the Pentateuch or Torah and particularly in the Code of legal purity (or Provisions for clean and unclean) of the Mosaic Law (Leviticus 11:1-15:33), it is stated that a woman undergoing menstruation is perceived as unclean for seven days and whoever touches her shall be unclean until evening (see Leviticus 15:19). Moreover, “if a man actually lies with her so that her menstrual impurity is on him, he shall be unclean seven days, and every bed on which he lies shall be unclean” (Leviticus 15:24). In other words, if a man has sexual relations with a menstruating woman, he is not perceived as unclean only until evening, but for seven days. When seven days pass from the beginning of menstruation, the woman is regarded as clean and thus, sexual contact is permitted. In another biblical passage it is stated that if a man has sexual relations with a woman during her menstrual period, both of them must be cut off from the community, for they have both been exposed the source of her blood flow (see Leviticus 20:18). The same biblical attitude to sexual relations during menstruation is also described in the following biblical passages: “You must not approach a woman in her menstrual impurity to have sexual intercourse with her” (Leviticus 18:19); “Say to the Israelites: A woman who becomes pregnant and gives birth to a son will be ceremonially unclean for seven days, just as she is unclean during her monthly period” (Leviticus 12:2); “But if a man is righteous and practices justice and righteousness, and does not eat at the mountain shrines or lift up his eyes to the idols of the house of Israel, or defile his neighbor’s wife or approach a woman during her menstrual period,…he is righteous and will surely live, declares the Lord God” (Ezekiel 18:5.6.9); “Men sleep with their fathers’ wives and have intercourse with women who are menstruating” (Ezekiel 22:10∙“The sins of Jerusalem”). These biblical sources were the reason for the attitudes of Judaism, as were the attitudes of subsequent religions which were influenced by Judaism, namely Christianity and Islam (2).

According to the legal concept of the Provisions for clean and unclean in Mosaic Law, some physiological human functions such as the woman’s menstruation and man’s sperm flow (ejaculation) were presented as unclean and abhorrent before God (see Leviticus 15). This was not because these functions were sins per se, but because they were connected, according to Jewish perception, to sin. Because of this connection, external impurity depicted the sin of the individual, while his external purity reflected his mental purity (4). So, a ritual (external) purity was required for the Israelites to achieve a moral (internal) purity. In Mosaic Law the concept of purity was interwoven with the concept of holiness, and therefore external purity was a necessary condition for the participation of Israelites in any ritual or worshiping event (4). The Israelites had to be cleansed in order to get rid of any contamination which was incompatible with the holiness of God. Otherwise, if those who were unclean approached and defiled His tabernacle, they would be killed because of their impurity (see Leviticus 15:31). Ways for men and women to regain their purity from normal or pathological unclean discharges included washing their clothes and bathing (see Leviticus 15:5.10.11.13.21.27) or the atoning sacrifice offering (see Leviticus 15:14-15; 15:29-30).

According to the New Testament and Fathers of the Christian Church, the character of these Provisions and Mosaic Law was generally mainly pedagogical (see Galatians 3:23-25; 1 Corinthians 10:6.11; Romans 15:4) and aimed at helping the Israelites to pass from physical purity to purification of the soul and from the worship of stereotypical rituals to spiritual worship where prophetic teaching is centered (4, 5). This explains their excessive rigidity and their meticulous obsession with detail, clearly related to their time of establishment and the spiritual level of the people they were addressing. According to the Fathers of the Christian Church, the main objective of the Provisions for clean and unclean was to inspire among the Israelites the concept of moral purity and respect towards the human body (cf. 1 Thessalonians 4:3-5; 2 Corinthians 7:1), although defining discharges as unclean is not real (5, 6). This cultivated a strong consciousness of sinfulness among the Israelites and helped them to get rid of it by acquiring moral purity (4). The Provisions, emphasizing the uncleanness of men or women’s discharges which were related with sexual functioning and childbirth (cf. Leviticus 15:3), was a strong reminder associated with the childbirth guilt of Original sin and thus a need for the Redeemer (5). Also, these Provisions protected or gradually detached the Israelites from the passion of prostitution and others unethical habits which characterized the neighboring polytheistic nations (cf. Leviticus 20:23), and pointed out to them (“pedagogy”) that the purpose of sexual intercourse was not carnal satisfaction but childbirth, and particularly the birth of healthy children (5). Moreover, the characterization of menstruating woman as “unclean” was limiting the man’s sexual desire given his bad psychosomatic condition at that chronic period (see the medical approach below) revealing the philanthropism in favor of the woman God’s providence. Considering that blood was the source of life (see Deuteronomy 12:23), the menstruating woman losing blood was losing her vitality and somehow separated from Yahweh who gives life. If these Provisions are not interpreted in these ways, their significance can easily be underestimated (4).

According to the New Testament, “the Law is only a shadow of the good things that are coming, not the realities themselves” (Hebrews 10:1; cf. Colossians 2:17). The New Testament draws our attention to seeking the spirit of the Law of God and to keeping it; not staying attached to the letter of the Law. God through Christ “made us adequate as servants of a new covenant, not of the letter but of the Spirit; for the letter kills, but the Spirit gives life” (2 Corinthians 3:6). When we come to know the Spirit of the Lord, we enter into an area of freedom where there is no submissive allegiance to the dead letter of legal schemes (see 2 Corinthians 3:17). In the New Testament, the Mosaic purity laws have been abrogated in Christ, with His words, His actions and His sacrifice on the cross (see Mark 5:5-34; 7:14-23; Matthew 15:10-20; 9:20-22; Colossians 2:14-17; Ephesians 2:15-16, etc.). In treating people who were considered unclean according to the Mosaic Law, such as the hemorrhaging woman (see Matthew 9:20-22; Mark 5:25-34; Luke 8:43-48) and lepers (see Matthew 8:1-4; Mark 1:40-45; Luke 5:12-16), Jesus Christ did not question the usefulness of the Mosaic purity laws generally, but rather their social utility since their aim should be not the exclusion of people from approaching God but facilitating their access to God. The words of Christ are distinctive: “The Sabbath was made for man, not man for the Sabbath” (Mark 2:27). We have to note that in the Church of the first Christians centuries there is the view that “for neither lawful mixture, nor child-bearing, nor the menstrual purgation, nor nocturnal pollution, can defile the nature of a man, or separate the Holy Spirit from him” (7).

Does the above mean that the Provisions of the Mosaic Law are of no value or obsolete in the new, after Christ, reality? According to Apostle Paul (see 1 Timothy 1:8-11; Colossians 2:20-23), the Provisions of the Mosaic Law are based on human commands and teachings and thus are of no value for the man or woman renewed in Christ, and furthermore are not enacted for the righteous, but for the lawless and rebellious persons, as prostitutes. We remind that for Apostle Paul, the word “prostitution” means not only the fleshly relationship with a prostitute, but any act of sexual instinct (libido) outside marriage, considering that the main and unique purpose of this act is the achievement of pleasure and not childbirth (cf. 1 Corinthians 7:2.5.9). It is important to note that according to Christian teaching, marriage is psychosomatic and not only a somatic union of a man and a woman (cf. Genesis 4:1); it is a society of human faces and persons, whose main purpose is mutual completion and their perfection (8). In this light of the New Testament, sexual contact that occurs during menstruation is considered as prostitution, since its unique purpose is usually the satisfaction of (man’s mainly) sexual instinct and the achievement of pleasure. Moreover, such contact does not usually lead to childbirth (see the medical approach below). We point out that in addition to Judaism and Christianity (1-3), Islam also forbids men to have vaginal sexual intercourse with their wives during menstruation. In particular, in the Quran Allah says the following: “And they ask you about menstruation. Say, it is harm, so keep away from wives during menstruation. And do not approach them until they are pure. And when they have purified themselves, then come to them from where Allah has ordained for you. Indeed, Allah loves those who are constantly repentant and loves those who purify themselves” (Surah al-Baqarah 2:222).

Medical Approach

From a modern medical point of view, the health risks from sexual intercourse with a menstruating woman are the following: I. Vaginal sexual intercourse without precaution (e.g., use of condom) during or shortly after menstruation is a risk factor for the heterosexual transmission of human immunodeficiency virus (HIV) or other sexually transmitted pathogens and the subsequent development of sexually transmitted diseases (STDs) affecting, inter alia, the health of the reproductive tract (9-15). Although sexually transmitted pathogens can be transmitted regardless of menstruation, they may be passed on more easily during menstruation (both from woman to man and vice versa) (10). We also note that infection from chlamydia and gonorrhea are important preventable causes of pelvic inflammatory disease (PID) and infertility (9). Untreated, about 10-15% of women with chlamydia will develop PID (9). Chlamydia can also cause fallopian tube infection without any symptoms. PID and “silent” infection in the upper genital tract may cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, which can lead to infertility (9). The transmission of STDs during menstruation is facilitated by loss of the protective barrier (cervical mucous plug), the presence of iron in the menstrual fluid, the dilated cervical opening, the elevated alkaline pH of the vagina and the premenstrual peak of estrogen and progesterone (12, 16, 17).

II. Vaginal sexual intercourse with a menstruating woman could lead to an increase in the flow of menstrual blood (18), because the veins of the uterus are congested and prone to rupture, and thus are damaged easily. Some women actually notice that their period stops one or two days after sexual intercourse. This phenomenon occurs because sexual intercourse causes contractions in the uterus resulting in the menstrual material to expel more quickly and hence the menstruation to stop faster than usual.

III. Although the chances of pregnancy during unprotected menstrual sexual contact are very small, they do not completely disappear. This occurs because sperm can survive within the woman’s body for a few days and, in the case of premature ovulation (e.g., short menstrual cycle of 21 to 24 days), can cause pregnancy, which is undesirable most of the time.

IV. Vaginal sexual intercourse during menstruation is a possible risk factor for the development of endometriosis. Endometriosis is a hormone-dependent, chronic inflammatory gynecological disorder characterized by the presence of endometrial tissue in sites other than the uterine cavity (19, 20). Endometrial lesions are primarily located on the pelvic peritoneum and ovaries but can also be found in the pericardium, pleura, lung parenchyma, and even the brain (20). This disease affects approximately 10% of reproductive-aged women and 20% to 50% of infertile women (20). The etiology of the disease likely reflects retrograde menstruation, coelomic metaplasia, or both (20). However, it also involves a complex interplay of genetic, anatomic, environmental, immunologic and infectious factors (19-22). Common clinical symptoms include pelvic pain, dysmenorrhea (cyclical pain associated with menstruation), dyspareunia (pain with or following sexual intercourse) and abnormal uterine bleeding and infertility (21). In addition, endometriosis may negatively impact mental health and quality of life and for this reason, affected women may have an increased risk of developing psychological suffering as well as sexual problems due to the presence of pain (21, 23). There is controversy in medical bibliography about the role of menstrual sexual intercourse in the occurrence of endometriosis. Filer and Wu (24) found that infertility patients who frequently or occasionally engaged in coitus during menstruation were almost twice more likely to have endometriosis than those who did not report coital behavior during menses, while such coital activity was unrelated to PID. The authors proposed that this difference may be due to increased intrauterine pressure during orgasm, which assists in the transport of endometrial debris to an ectopic site (24). In a study (25) focusing on the belief that women with endometriosis typically delay childbirth, no association was found between orgasm and sexual penetration during menstruation and endometriosis. Another investigation (26), which was designed to examine if sexual activity and hygienic practices during menstruation are associated with an increased risk for the development of endometriosis, revealed that sexual activity, orgasm, and tampon use during menstruation may confer protection against endometriosis.

V. Sexual intercourse during menstruation can affect negatively the man’s sexual desire (libido) and make him temporarily impotent because of the presence and smell of menstrual material. Also, the bad physical and psychological state of women before (e.g., premenstrual syndrome [PMS]) or during menstruation due to a variety of factors (e.g., painful cramps [dysmenorrhea], anxiety, depression, migraine headaches, low blood pressure, and reduction of temperature) most times does not favor their mood for sexual intercourse.

Vaginal sexual intercourse during or shortly after menstruation was suggested in the Hippocratic corpus, a compilation of Greek medical texts written by various authors throughout the 5th and 4th centuries BC and subsequently associated with the renowned physician Hippocrates of Cos (c. 460–c. 370 BC). This suggestion was based on the incorrect view of Hippocratians about conception, as they considered the last few days of menstruation as fertile days (see On the Eighth Month’s Fetus: 13, On the Nature of the Child: 15, Diseases of Women 1: 11 and 17) (27). Among the gynecological diseases and syndromes in the Women’s Books of the Hippocratic corpus, STDs and various inflammations of the female reproductive system are described as causes of female infertility (27). The conditions for transmission of these diseases appear to be favorable mainly due to ignorance of pathogenic bacteria and viruses at that time, men’s sexual habits, and sexual intercourse during menstruation (27). Also, several relatively unambiguous disease profiles that allude to the wandering womb and other symptoms suggestive of endometriosis have been identified in the Hippocratic corpus (28).

Commenting on the Provisions of the Mosaic Law about female impurity during their menstruation and its consequences (see Leviticus 15:19-30), we believe that these were Jewish beliefs imposed mainly by social and cultural principles of the time, which were then invested with religious authority (cf. Colossians 2:22-23). These were historical creations directed at specific people of a particular era to achieve specific goals. Thus, it cannot be ruled out that the classification of a menstruating woman as unclean and the prohibition of sexual intercourse were to protect her from the transmission of STDs given the inadequate conditions for hygiene of her body, the ignorance of the existence of microbes and viruses, the absence of condoms and so on at that time. This view is advocated by the order to purify the body with water, not only for the unclean men or women, but also after every sexual intercourse (see Leviticus 15:17). It is obvious that compliance with hygiene rules during sexual intercourse would increase the fertility of men and women and would surely contribute to the birth of healthy offspring, just as God had promised to Abraham (see Genesis 15:1; 22:17) (29). So, the term “unclean” for a menstruating woman served this aim. We must also not overlook the fact that the Provisions of the Mosaic Law were laid down during the 12 months of the Israelites’ stay in the Sinai desert and that these rules had to be applied then under the difficult hygiene conditions of the barren, dry, warm and inhospitable deserts of the Sinai Peninsula. These Provisions, aiming to promote the health of Israelites and prevent them from contracting STDs, proved God’s providence for the preservation and growth of His chosen people. In modern times, the prohibition of sexual intercourse during menstruation and other relative sexual hygiene rules might have a significant benefit for people of a similar social and cultural status and circumstances to people of that time (30-32). Besides, we cannot ignore the fact that the Old Testament and the Mosaic Codes provided the basis for modern public health and hygiene rules (preventive medicine) practiced in our times (33). However, the characterization of menstruating women as unclean, interpreted according to the letter, and not in the spirit of the Mosaic Law, is undoubtedly a violation of women’s personality.

Although sexual intercourse without precautionary measures during menstruation is likely to be the time of the greatest bacterial contamination of the reproductive tract, it is normal and not perversion. It is sufficient that the couple know and apply the rules of safe sex to avoid an undesirable pregnancy and to prevent the development of STDs or possible endometriosis. The same rules are also suggested in the case of sexual intercourse when the woman has no menstruation. It is very important for the menstruating woman not only to be released from taboos and prejudices that make her feel guilty and a shamed, but also mainly to understand that she is not “unclean” and that she must have a healthy attitude and respect towards her body. For such sexual intercourse there must be the consent of both. The above-mentioned health risks are not God’s punishment for breaking His commandments regarding sexual intercourse as some claim, but the price of applied sexual behavior and choices. Let us remember the words of Apostle Paul: “Everything is permissible for me, but not everything is beneficial. Everything is permissible for me, but I will not be mastered by anything” (1 Corinthians 6:12).

CONCLUSION

The Provisions for clean and unclean of the Mosaic Law were essentially hygiene rules imposed by the social and cultural data of that time and invested with religious authority. Their main aim was to foster the Israelites’ health, prevent them from contracting STDs, increase their fertility and promote the birth of healthy offspring.

Conflicts of interest: none declared.

Financial support: none declared.