http://www.sexualityandu.ca/teens/contraception-2-2.aspx

I heard this is halachically problematic since the patch can't be removed so it's a chatzitzah in the mikvah.
However, be-di'avad, would it really be considered an invalid tevilah? I would think that something is a chatzitzah if you are makpid that it shouldn't be there but if you davka want it, it's not a chatzitzah. For example, some people claim you can leave stickers on glassware if the sticker increases the value [eg. it's a sticker that attests to the designer and therefore increases the worth of the stemware] when you tovel the dishes. Wouldn't that be the same case here?

I believe it was taken off the market due to health concerns anyway.

Regardless, the question stands. And just looking around the Internet, it seems to me there are indeed patches available, at least in Canada.

Yes it would make sense that it's a chatzitzah. You could take it off right before dipping, dry off and put another one on though.

I'm not convinced be-di'avad. Obviously initially one should have no interposition whatsoever, and that's how we are commonly noheig. But I'm asking be-di'avad, let's say the person was already intimate, and she forgot she had her patch, or even if she did it on purpose, be'dia'avad, would it be an invalid tevilah?


Would that be equally efficacious pharmacologically? Is it then merely a matter of needing more patches ie an added expense and a bit more scheduling awareness?

I dont believe thats true, at least for the USA.

For Melech's question- According to the check sheet in my mikva, they are supposed to be removed.
Even if she wants it on, isn't it big enough that most people would would mind if it was there? that would make it a problem (d'orysah),

Again, obviously initially that's how we're noheig. But I'm asking bedi'avad, al pi halachah.



I don't think so. But I don't really know, and hence the question.

The patch can be safely removed for the couple of hours necessary to to a chaffifa/tevillah.

As far as chatzitza goes, I would imagine that it is a chatzitza as it is not loose, and wouldn't let the water pass through. Although it likely could be classified as a "miyut sh'ayna makpid," the Rama (if I remember correctly) in the beginning of YD 198 states that we are makpid even on that. Also, to say that she davka wants it there I wouldn't think is a valid argument. We know that a woman isn't allowed to wear a ring in the mikvah; why? Because there are times (when she needs to knead dough or the like) that she would insist on taking it off. Even if those times are few and far between, still the ring is a chatzitza, even if now she wants it on. So in the case of the patch, she has to take it off for 1 out of 4 weeks, I would think that for sure it is "worse" than the ring.

I have never heard of what you mentioned about something that increases the worth of something not being a chatzitza, but that doesn't mean that there aren't svoros like that. Do you have a source to refer me to?

See my prior post about a woman's ring. In the case of a ring, I believe it would be vaild b'diavad if it was a loose ring that allowed water to get through. But in the case of a patch, I don't think the water will get through, and I would thus think that even b'diavad it is no good...although, the psak halacha might be different depending on when she asked, i.e. if she had already gone home to her husband.

Isn't miyut u'makpid alright D'oryasa?

midwestyingle:

The Rama at the beginning of 198 specifically says lechatchilah. Again, hence my question. I acknowledged above lechatcilah it should be removed. I'm asking be-di'avad, al pi halachah. The Rama's view is a chumra.

As for stickers, there's a footnote in R. Zvi Cohen's Tevilath Kelim p. 73 footnote 6:
"According to the authorities who maintain that when a storekeeper immerses his utensils the tevilah is valid, it appears that there is no need for them to remove the labels beforehand. They are not concidered chatztzitoth since they want the labels to remain on the utensil to that the buyers will know they are new".



But here she specifically does not want it removed.

Thanks for the source. I can't put my finger on exactly why not, but it doesn't seem to me that you can compare what R' Cohen said about the keilim to the nidon didon of patches on a woman's body.

What if we say its not a chatzitzah because she wants to be there and its permanent... like a tooth filling. Except that this isnt something worn for longer than 30 days. Its very temporary- its going to be replaced within a week (yoatzot example) so I dont think this line of thinking would work.

As far as I learned that case would be ok, but I don't have a "sefer source" for it.

Any relationship to the chinuch patch?

Thats not the way the patch works medically though. You put it on on the 5th day of the period and it works most effectively if you do not take it off again until the end, since adhesion is key to its effectiveness. If you take it off, there's more of a chance it won't give enough of the hormones, making it a pretty useless form of birth control. In theory, you could take it off before mikvah (after wearing it for only 7-9 days) and then going in the mikvah and using a new one but that would get costly. With my insurance, brand name medications like this cost $40, making this 2-patch system cost $80/month.

As to melech's original question, I actually heard a similar shaila about the NuvaRing (a birth control form which a woman insterts inside of her for 3 weeks and then removes, same system as the patch where she puts it in on the 5th day of the period). The NuvaRing must be removed for tevila, but I was surprised to find out that b'dieved, they are much more lenient. If one happens to wear it inside without knowing it, the tevila is not invalid. I reiterate, this was the opinion of one rabbi and definitly b'dieved. I would assume the situation is similar with the patch. The only thing that would be different to consider is that the patch has a phisical film that attaches it, which is often considered invalid tevila. Don't quote me on this, but I thought that if you found dirt on your skin after tevila you had to reimerse.

Correct. It was never take off the market in the U.S.

I'm just guessing, but maybe perhaps a NuvaRing is different if it's considered inserted deeply enough that it's in an interior surface, where rules of chatzitzot don't apply, rather than in a beit ha-setarim. See R. Bodner's The Laws of Niddah, page 300, footnote 165.

Right I would never recommend taking it off and putting it back on again. One would have to put a new one on. Sure it's expensive, but for people who have trouble remembering to take a pill and want hormonal contraception, this is an option.


Well I'd imagine that the NuvaRing wouldn't be nearly as much of an issue. It's not like the tevillah water is going there anyway - it's not an external thing. The patch is literally on your skin like a sticker.


Well I remember reading articles about a higher risk of blood clots than with other methods of hormonal contraception but what do I know.

A two patch system, over time, would be $50, not $80, since you would only need one extra patch per cycle. r
Mind you, I suppose one would need extra prescriptions - if the physician is dispensing a 3-month supply, you'd really need a 5-month supply every 4 months. Oh wait, the math doesn't work. You need what, 3 patches per cycle? So you'd need a four month supply every 3 months from the physician.

You're right, the risk of blood clots is higher for the Ortho Evra patch specifically vs. regular birth control pills, but it's not so high that it was taken off the market.

Isn't there a back-to-back system for the patch (so that one doesn't bleed every month) like there
is for BC pills - if so it isn't every month that one has to replace after mikvah .

You can take any standard forumula BC pill back to back. You can't use the super low estrogen formulas though to do this.

Can you take a patch off early and put a new one on, like if you are taking it off for mikvah? In other words, is the hormone delivery constant at the beginning of patch use and throughout its use?

Isn't a consistent stream of medication one of the reasons behind transdermal medications!
If it started high dose and by day 5 was giving less medication, this would not be an effective form of dosing medication. This is new technology, but it has really taken off and gotten popular in the past few years. They have patches for nicotine, pain management, various hormone treatments....

So why do have to change the patch every week? It delivers 100% consistent dosage for one week, and then suddenly tapers off?
In theory, could you put a new patch on every day for three weeks?

If you liked to waste money, I dont see why you couldn't buy 21 patches and put new ones on every day for 3 weeks
Well, maybe thats not smart because I dont know if there is a lag time between putting it on and the medication entering the blood stream.

I assume they are made with 7 days worth of meds, nicotine patches usually are a day worth, the pain ones I saw were 3 days.....

I'm asking because I'm trying to determine if patches are really halachically problematic, as per the opening post. I want to know if simply taking off the patch, and putting on a new one after mikvah, would solve the problem. If that's the case, it's not really a halachic impediment, it's simply a financial impediment, maybe $10-20, whatever a single patch is worth.

Somebody told me, in essence, patches aren't good halachically because they are a chatzitzah and you can't take them off. I believe that to be incorrect, and I'm trying to determine if I'm right or wrong.

Ok, I dont see a medical reason why someone could not not remove one and put on a new one after, as according to my understanding of the technology, it doesn't seem to effect dosage.

There are Rabbis that hold you can toivel with the NuvaRing.

In theory, yes. But you have to be VERY careful about shifting around BC dosages. One of the leading ways people get pregnant using BC is by waiting too long to restart the active pills/putting on the patch/ putting in the ring.

I misunderstood about the patch, I didn't realize you put it on once a week. In that case, it is somewhat more plausable that you could take it off for the mikvah, since you put it on around the time of HT and then take it off to change one at the exact time of mikvah. This ONLY works though if you can get a good HT on the 5th day (i.e. the day you would start your patch after beginning the patch-free period week). If you need an extra day for HT (as many women do), your whole system is going to be off. The day you have to change your patch is the day BEFORE mikvah. There is a chance you won't get pregnant even if you leave it on that extra day, but if a frum woman is taking BC it's usually because she wants to be absolutly positive she's not going to get pregnant. You don't want to take the chance.

Right, I'm just pointing out that there are rabbis who disagree to add complexity to melech's question. Just like the Nuvaring, I have a hunch that he's going to have trouble finding a solidly accepted opinion.

I wasn't clear. I'm assuming the person starts the patch whenever. When do they normally start, a week after the last menstrual period started? I have no idea. But let's assume early in the sheva nekiyim. So she's still wearing the first patch on mikvah night. Let's say it's day six. So she takes it off when getting ready for mikvah, and a half hour later she puts on patch number 2, which she wears for a day, when she takes it off and switches it for patch 3, when she would have had to switch to patch 2. She wears it for a week, then switches patches. She wears the last one for a week. So she wore 4 patches for a 3 weeks, having had a patch off for just the half hour of mikvah.

Just to be nitpicky, it is day 5 of the hormone free cycle that she first puts on the patch, which can sometimes be just a day or two into the actual bleeding. This is one of the reasons some women take BC, in order to shorten their cycles, because it is much easier to get clean in 5 days due to the hormonal interference.

In any case, the situation you have is plausable, the only restriction possibly is that extra $25 you'd have to spend per month for an extra patch to wear for a day. It still doesn't take care of the fact that a patch is not a naturally occuring substance. It is the essence of a chatzizah, it's something stuck to the body that can and should be removed, along with any gunk attached to it.

http://www.yoatzot.org/question.php?id=2346

is that what the patch is?

Excuse my ignorance.

The patch actually has one of the highest concentrations of estrogen in commonly taken BC formulas. I'm not sure why, perhaps because of the delivery method.

What? No, your system makes no sense and is a waste.
Say she switches to patch 2 a day early (day 6). The new one has a week worth of medication. She then wears that one for a week. Just move the "change day" up a day.
Example- Say switch day should be wed., but shes at the mikva tue and needs a new one. Next week she'd need a new one on tue.

It doesn't matter. It's still going to be 4 patches over a three week period. At the end of three weeks, there will be a patch that hasn't been completely used. And hence the added expense of one extra patch per cycle.

No, if you start 1 on on hefesk tarah day, then if works out perfectly. If she cant swing that, then yes there needs to be a 4th.
But your system a few posts didn't add up- you wasted a whole week. If you said she needed #2, for 2-3 days pre mikva that sounds more plausible situation.
What you are not calculating is that even though you need to use one more, I think you also gain a few days, so its more like 3.5 week.

No. Granted if you start the patch on HT then you change patches on mikvah night, all is good. But if you don't, if you start patch 1 either before or after the HT, you'll still need four patches for the 21 days of patch use. The only difference is whitch patch[es] isn't used up.

Wait you edited.
You are wrong about the 21 days. You need to keep in mind that every round is 7 days

Fake calender:
Late Mikva
1# Sunday-> Sunday = 7 days
2# Sunday -> Tues Mikva = 3 days
3# Tues -> Tues = 7 days
4# Tues -> Tue = 7 days

#2 gets under used, but the total coverage days is 24

What about an early mikva?
1# Sunday -> Friday Mikva = 6 days
2# Friday -> Friday = 7days
3# Friday -> Friday = 7days

#1 gets under used, but you still get 20 days, if you want to add a 4th week, your total adds to 27.

Week 1: No patch - period
Week 2: Patch 1 - Clean days
Week 3: Patch 2 which is removed right before the mikvah. Patch 3 is put on right after the mikvah.
Week 4: Patch 4

So basically four patches are being used per month instead of three. If you time it perfectly, you can remove Patch 2 exactly seven days after Patch 1, go to the mikvah and then put on Patch 3 which should last you till the end of week four but I wouldn't rely on that kind of timing if it were me.

see my above edit. My point is, yes 3 over a month, but its not going to add up to 21 days.

Well the month and how many days it has doesn't matter. You pick a day of the week and do it by week. Three weeks on, one week off. Very simple.

Of course the days matter- if you are wasting one/paying money extra, you can get more days out of it than 21....
4:24-27 days is much better yield than 4:21 days

Obviously you can stretch out 4 patches longer than 21 days even with having to prematurely end one early because of mikvah. But I'm assuming a person is keeping to a 21/7 schedule.

Now I see what you meant by "wasting a whole week" - because you are trying to maximize the patches. That didn't enter my mind - I was just working out that if a person sticks to a 21/7 schedule, if there is an intervening mikvah when a patch has to be removed, then you will need 4 patches per cycle for the 21 days except for the special case where you were going to switch patches on mikvah night anyway.

Yes, other than in the special case where the first patch ends on mikvah night anyway, you will be able to extend the 4 patches beyond 21 days.

Supplemental: Is there anything wrong with extending patch use beyond 21 days? Let's say you want to delay niddah.

Dr Google says its fine. Thats called continuous therapy, and is prescribed to women with severe PMS, endometriosis etc.

Obviously you MUST change the patch. Not changing the patch is bad news if you don't want to get pregnant. Lots of women use BC back to back, skipping the period days. The problem halachically that people run into is that often, the body just can't get used to this system, or the hormone level isn't high enough to counteract the influx of hormones the body naturally secretes during PMS time, and it will cause a lot of breakthrough bleeding. That bleeding can either be the form of continual spotting, which can be controlled to a point by wearing dark underwear so as not to see the bleeding, or it can just be a lighter-than-usual flow which would be difficult for a woman to ignore. Complicating things halachically is that generally, this spotting will happen around an ona and the bedika would render one niddah. This is effective for those who need to lessen the symptoms of menstruation (say, for endometriosis or fibroids) but it doesn't always work for delaying niddah.

If this is the plan, a woman should speak with her specific doctor about perscribing the right BC with the right hormone levels to lessen the chance of spotting. As I've said before, the patch has a high level of hormone levels and is probably a good match for this, but it isn't always the first choice for frum women because of the mikvah issue.

Right, I'm assuming using more than 3 patches, where no patch remains longer than 7 days.


Yes, but I thought we established a consensus in this thread that the mikvah issues isn't really an issue - it's a monetary issue that you would need one extra patch per cycle.