If a woman sees blood that she knows comes from her uterus but did not feel any accompanying sensation – is she a nidda mide’oraita or do we only apply the laws of ketamim? In order to answer this question, we need to study the sources concerning hargasha, the internal sensation of becoming a nidda, in the Talmud and later commentaries.
The Torah writes:
וְאִשָּׁה כִּי תִהְיֶה זָבָה דָּם יִהְיֶה זֹבָהּ בִּבְשָׂרָהּ שִׁבְעַת יָמִים תִּהְיֶה בְנִדָּתָהּ וְכָל הַנֹּגֵעַ בָּהּ יִטְמָא עַד הָעָרֶב.
If a woman has a discharge, her flesh discharging blood, she shall remain in her state of menstrual separation for seven days, and whoever touches her shall become impure until evening.
On this verse, the Amora Shmuel comments:
אמר שמואל: בדקה קרקע עולם וישבה עליה, ומצאה דם עליה – טהורה, שנאמר “בבשרה” – עד שתרגיש בבשרה.
Shmuel said: If a woman checked the ground (for blood) and sat down, and then subsequently found a stain, she is tehora (ritually pure), for the Torah states: “In her flesh” – [meaning that a woman is pure] until she senses [the menstruation] inside her body.
Commentaries suggest a number of different approaches for how to relate to this statement. The first approach is that a “sensation” of blood flowing from the uterus is causative. According to this view, any blood that the woman sees without a hargasha will not make her a nidda mide’oraita. In the instance of an internal exam or certain other extenuating circumstances, we may say that she is a nidda de’oraita misafek, meaning that we are not sure where the blood came from, but we have good reason to believe that it came through hargasha.
Period after all footnotes? Some?
In this view, it is the hargasha itself which causes the change in status to a nidda de’oraita. According to this understanding of Shmuel, even blood found inside of the body but without a hargasha will only be capable of rendering a woman a nidda miderabanan, or, according to some authorities, a safek nidda de’oraita.
The second possibility is that Shmuel is making a statement about the way that the world typically works – usually, menstrual bleeding will be accompanied by a hargasha. It is not the hargasha itself which renders a woman a nidda de’oraita; instead, the hargasha is indicative of menstrual bleeding. This understanding of Shmuel is potentially far more impactful than the first – if one is positive that the blood came from the uterus, even if there were no hargasha whatsoever, the woman would still become a nidda de’oraita. The hargasha merely acts as the prime, typical indicator that this blood is menstrual blood. Although this means that most of the time when a woman bleeds as part of her monthly menstrual cycle, she will be a nidda de’oraita, there is still ample room for the rules of ketamim in this view, since any case where we are not sure of the provenance of the blood, we will apply the rules of ketamim.
A third potential way of interpreting the sugya is to acknowledge that Shmuel is saying that a hargasha is causative, but not to rule in accordance with his opinion as the practical halacha. On a practical level, this view yields a similar conclusion to the second view although it places no special status whatsoever on the hargasha. In the second view, a hargasha would undoubtedly render a woman a nidda de’oraita when accompanied by blood, while according to this third approach, it is merely one indicator among many potential indicators, and would certainly not make a woman impure if not followed by blood.
Hargasha is Causative
This view seems to be the most comfortable fit with the simple reading of the Gemara. Shmuel is offering a derasha from the pasuk and appears to say that the Torah requires a hargasha in order to render a woman impure. This is the view of the Rambam, who requires both blood from the womb and hargasha for nidda de’oraita. Nevertheless, he writes that blood found on an internal exam will render a woman a nidda de’oraita even if it was found without a hargasha. This is because there is a presumption that blood found on an internal exam is accompanied by a hargasha of which the woman was unaware.
The Hagahot Maimoniot relates that this is the opinion of his teacher, the Maharam Rotenburg, as well. The Maharam Lublin arrives at this same conclusion as well through an analysis of the next part of the Gemara. The Gemara brings three cases which potentially contradict Shmuel’s ruling and explains why each one is ultimately not a problem. The Maharam Lublin focuses on one of those cases:
תא שמע: האשה שהיא עושה צרכיה וראתה דם: רבי מאיר אומר אם עומדת טמאה ואם יושבת טהורה. היכי דמי? אי דארגשה יושבת אמאי טהורה? אלא לאו דלא ארגשה וקתני עומדת טמאה? לעולם דארגשה ואימור הרגשת מי רגלים הואי עומדת הדור מי רגלים למקור ואייתי דם ויושבת טהורה
Regarding a case of a woman who is urinating and finds blood in her urine: Rabbi Meir says that if she was standing, she is temei’ah and if she was sitting she is tehora. [The Gemara asks:] What is the case here? If she had a hargasha, why is she tehora if she sat down? And if she did not have a hargasha, why is she temei’ah if she stood up? [Explains the Gemara:] Rather, say that she had a hargasha and we attribute that hargasha to the feeling of urinating. But when she is standing, it could be the case that the urine went back up and came out of the uterus [and therefore made her temei’ah].
The Maharam Lublin writes that if a hargasha is merely indicative and not causative, and the Torah is only interested in whether the blood certainly came from the uterus of the woman, why would the woman be temei’ah when she urinated while standing? Even in such a case, there is no certainty that the blood came from her uterus – indeed, the Gemara only says that it is a possibility. Therefore, says the Maharam Lublin, a hargasha must be causative, and once we have reason to suspect that a particular feeling is a hargasha, we will say that she is temei’ah.
Rav Akiva Eiger holds this way as well, but he proves his position from elsewhere in the Gemara. The Mishna discusses various situations in which a couple was intimate and then found blood, which raises the concern that at the time of intercourse, the woman was already a nidda. The Mishna distinguishes between various times and places where the blood was found – whether on his sexual organ or hers, and how much time after the intercourse the blood was located. In the course of its discussion, the Mishna writes:
נמצא על שלה לאחר זמן טמאין מספק ופטורים מן הקרבן.
If blood was found on her (bedika cloth) after some time has passed, they are both impure out of doubt but are exempt from bringing a korban.
Rav Akiva Eiger, based on Rashi, understands that this Mishna does not only address their status at the time of intercourse, but their status at later points as well. If that is correct, he asks, why are they only impure misafek? Surely, if the blood was found on her bedika cloth, even after some time has passed, it must have come from her and should therefore render her temei’ah with certainty! Rav Akiva Eiger therefore concludes that hargasha must be causative and not indicative; consequently, they are only impure misafek because there was no hargasha.
Some commentaries take this opinion to its logical extreme and understand that if a woman performed an internal exam and was confident that she did not feel anything, then on a de’oraita level she would be tehora, as we mentioned above.
Hargasha Is Indicative
Who are the dissenting opinions, and on what basis do they argue that hargasha is indicative? The Tosafot Rid is the standard-bearer of this school of thought, although as we will see, there many other Rishonim who seem to hold this way as well. The Tosafot Rid writes that the reason for Shmuel’s opinion that if a woman sat down on the ground, she is not temei’ah is that she did not know that the blood came from her body, and was able to attribute it to the ground not being checked well. It seems from here that were she to know that the blood came from her, either with an accompanying hargasha or without, she would be temei’ah.
A significant problem that the Tosafot Rid must address is the ruling of the Mishna we quoted above. If all that is required to make a woman temei’ah de’oraita is the knowledge that the blood came from her, why does the Mishna state that she is only considered temei’ah misafek? Surely, there is no more significant indication that the blood came from her than wiping after sexual intercourse! The Tosafot Rid answers that the Mishna there is not referring to her status going forward, but rather her status in the past. Since we cannot ascertain that she was, in fact, a nidda when the couple had intercourse, we cannot make them bring a korban. Further, we cannot definitively determine when she became temei’ah and therefore cannot burn all of the teruma she may have touched. However, the Mishna is not referring to her current status (as Rav Akiva Eiger understood), and therefore poses no contradiction to the position of the Tosafot Rid.
Before we move on to the opinion of the other Rishonim, it is essential to discuss the opinion of the Maharam Lublin at this point. The Sidrei Tahara addresses the proof of the Maharam Lublin that we brought above. He says that the assumption of the Maharam – namely, that the fact that the Gemara only listed it as a “possibility” that a woman could bleed from her uterus while standing and urinating while nevertheless saying that she was temei’ah meant that a hargasha must be causative and not indicative – is wrong. The Sidrei Tahara explains that we do not generally attribute blood in urine to a wound. Instead, we assume that one sees blood in this manner is one of the majority, who do not have wounds in their urinary tract. When a woman sits to urinate, blood from the uterus does not generally mix with the urine, and she is therefore considered tehora. However, when a woman stands to urinate, there is a possibility that the blood came from the uterus. Since most blood seen from a woman is from the uterus, the requisite level of certainty to render a woman temei’ah is present even if the hargasha is merely an indication.
Several other Rishonim also seem to believe that a hargasha is indicative rather than causative, as we will explain. The Gemara states in the continuation of the passage quoted above:
ועוד, תנן: הרואה כתם על בשרה כנגד בית התורפה – טמאה ואף על גב דלא הרגישה! אמר רב ירמיה מדפתי: מודה שמואל שהיא טמאה מדרבנן. רב אשי אמר: שמואל הוא דאמר כר’ נחמיה, דתנן – ר’ נחמיה אומר: כל דבר שאינו מקבל טומאה – אינו מקבל כתמים.
And further, it was taught: One who sees blood on her flesh opposite the vaginal area is impure, even if there was no hargasha! Said Rabbi Yirmiya from Difti: Shmuel would agree that the woman is impure on a rabbinic level. Rav Ashi said: Shmuel follows the opinion of Rabbi Nechemya, as it was taught: Rabbi Nechemya says, anything which cannot become ritually impure is not subject to [rabbinic impurity of] bloodstains.
Rashi, commenting on the words of Rav Ashi, writes:
רב אשי אמר – טעמא דשמואל דאמר לעיל בדקה קרקע עולם כו’ לאו משום הרגשה אלא כרבי נחמיה ס”ל דאמר לא הזכירו חכמים גזרת כתם אלא על דבר המקבל טומאה הלכך כל הנך תיובתא לאו קושיא נינהו דשמואל לא איירי בהרגשה כלל.
Rav Ashi said –Shmuel’s reasoning above when he presented the case of checking the ground [before sitting down, where the woman was tehora despite finding blood], had nothing to do with hargasha. Instead, it was [because Shmuel held] like Rabbi Nechemya, who holds that there is no gezeira of ketamim (bloodstains found without a hargasha) on things which cannot become ritually impure… Shmuel is not talking about hargasha at all.
The Sidrei Tahara explains that Rashi understands that when Shmuel was quoted in the Gemara as deriving from the pasuk that a woman must have a hargasha in order to be rendered a nidda, he was saying that a hargasha is an indicator of menstrual bleeding, not a causal factor. Therefore, even in a case where the ground was checked, and there was no blood, we say that it was not checked well. He writes further that since we know that most blood that a woman sees comes from the uterus and that most blood comes through a hargasha, when there is not a hargasha, it is an indicator that the blood did not come from the uterus. However, if there is other evidence to suggest that it did, then the woman would still be temei’ah de’oraita. If there was not sufficient evidence, but there was reason to suspect that the blood came from the womb, we would say that she is temei’ah miderabanan based upon the rule of ketamim. This also seems to be the opinion of the Rosh, as he does not quote the ruling of Shmuel at all in terms of hargasha.
The Tur, son of the Rosh, formulates his opinion in a quite unclear fashion, from which the Sidrei Tahara extrapolates that he too holds that a hargasha is indicative. The Tur writes:
דבר תורה אין האשה מטמאה ולא אסורה לבעלה עד שתרגיש
According to the Torah, a woman does not convey impurity and is not forbidden to her husband until she has a hargasha.
The Sidrei Tahara asks: Since when is a hargasha necessary for making a woman temei’ah for kodshim and taharot? We have a principle in halacha that all blood is assumed to be impure and will render a woman temei’ah for the purposes of eating kodshim and taharot without any reference to a hargasha! Furthermore, why would the Tur address this issue if there are no applicable laws today regarding those areas of halacha? Therefore, the Sidrei Tahara concludes that the Tur must hold that a hargasha is indicative and not causative, and he phrased the halacha in this manner to teach us that a ketem without a hargasha is only considered of rabbinic status. If, though, it clearly came from her body, she is temei’ah de’oraita, and there is no difference between taharot and kodshim and tumat nidda.
Even those authorities who claim that a hargasha is an indicator of menstrual blood will agree that ketamim are still in effect in a wide variety of situations. However, when the blood is identified as almost certainly having come from the womb, as in when it is found on clean undergarments, it seems that those authorities would rule that the woman is a nidda de’oraita.
There is still much to be explored in our quest to understand how the Torah and the Sages viewed menstrual blood and spotting, and how that view translates into modern-day practice. Even among those authorities who rule that a hargasha is a causative phenomenon and that a ketem is defined as any blood seen without a hargasha, it is worth exploring how the dinim of teliya (attribution) work with modern hygiene and clothing practices.
 Vayikra 15:19
 Nidda 57b
 See the Gemara quoted above for three cases of where this might be the case.
 Some shitot take this to the extreme; see, for example, the Terumat HaDeshen (siman 246) where he writes that a woman is a safek nidda de’oraita if she had a hargasha even if there was no blood, since we assume that some blood came out and was absorbed by the body.
 See Hilchot Issurei Bi’ah 5:4 and 9:1.
 Hilchot Issurei Bi’ah, ch. 4
 Responsa of the Maharam of Lublin, siman 2
 Nidda 57b
 Hagahot to Nidda 14a
 Nidda 14a
 See Lechem V’simla, y.d. 183:2 and Sidrei Tahara, y.d. 190:93, s.v. ach divrei she’ar haposkim
 Commentary to Nidda 57b
 Nidda 14a
 Piskei Rid, Nidda 14a
 Sexual relations with a nidda engenders a chiyuv kareit and would require bringing a korban if done unintentionally.
 If a nidda touches food that must remain tahor, that food must be burnt. If a safek nidda touches it, it cannot be burnt, but must not be eaten, and is left to rot.
 Siman 190
 At least according to Rabbi Meir; Rabbi Yosei disagrees.
 According to his understanding of science in his day.
 See there at length for other proofs from Rashi that hargasha is an indicator and not a cause. For example, Rashi (Nidda 62b) writes that a woman is not temei’ah until she “sees in her flesh.” From the fact that Rashi did not write that she “feels in her flesh,” the Sidrei Tahara infers that a hargasha is only an indicator.
This is known as “mekor mekomo tamei,” the place of the uterus is impure.
 See the Bach here who also asks this question.