Written and collected by Zia H Shah MD, Chief Editor of the Muslim Times

Background on Qur’an 2:222 and Menstrual Intercourse

In Qur’an 2:222, Muslims are instructed regarding menstruation: “They ask you about menstruation. Say, it is a harm (Arabic: adha). So keep away from women during menstruation, and do not approach them until they are cleansed…” (interpretation). In essence, the verse prohibits sexual intercourse during a woman’s menstrual period, characterizing the menstrual flow as a source of harm or discomfort. This commentary will explore modern medical and scientific insights into menstruation and associated health risks, highlighting how the Qur’anic injunction aligns with sound health practices. We will focus on gynecological facts about menstruation and the medical risks of intercourse during menses – such as heightened infection risks (sexually transmitted infections, bacterial imbalance), inflammation, and other reproductive health concerns – all from an evidence-based perspective. No classical religious exegesis is discussed; instead, the goal is to see what contemporary medicine says about intercourse during menstruation and whether it validates the wisdom of avoiding it at that time.

The Menstrual Process: A Gynecological Overview

Phases of the menstrual cycle, highlighting menstruation (shedding of the uterine lining) at the beginning of each cycle. During a typical menstrual period, the endometrium (uterine lining) that had built up over the month breaks down due to hormonal shifts and is expelled as menstrual blood through the cervix and vagina​. In each cycle, rising estrogen and progesterone prepare the uterine lining for possible pregnancy; if no fertilized egg implants, hormone levels fall, triggering the uterine lining to shed along with blood and mucus​. Medically, this process is essentially a natural inflammatory event – the endometrial tissue becomes inflamed and the superficial layer is sloughed off​. The shedding phase typically lasts about 3–7 days for most women and marks the start of a new menstrual cycle.

From a gynecological perspective, menstruation leaves the inner uterus in a delicate state. As the lining is shed, the uterine surface is temporarily raw and exposed until it heals and regenerates. The cervix (the lower end of the uterus) also undergoes changes during this time. Normally, the cervix is closed by a small opening, but during menstruation the cervical opening widens slightly to allow blood and tissue to pass​. The cervix also tends to sit a bit lower and feels firmer during menses​. This slight dilation and exposure, while necessary for menstrual flow, can have side effects: it may provide a pathway for microorganisms to enter the upper reproductive tract more easily than when the cervix is tightly closed. In essence, during menses the uterus is in a state of cleaning itself (through bleeding) and is somewhat more vulnerable – a point to keep in mind when considering intercourse at this stage.

Elevated Infection Risks During Menstruation

One of the clearest medical concerns with intercourse during menstruation is an increased risk of infections, particularly sexually transmitted infections (STIs). The menstrual blood itself can carry blood-borne pathogens, and exposure to a partner via sexual contact raises the chances of transmission​. For example, HIV and hepatitis viruses are present in blood; unprotected sex during menstruation means a partner could come into direct contact with menstrual blood containing such viruses. Health experts specifically warn that “HIV is contained in blood and may be transmitted through contact with menstrual blood containing the virus.”​

In other words, if one partner carries a blood-borne STI, having intercourse during menses makes it easier for the infection to spread, compared to sex at times when blood is not present as a medium.

More broadly, epidemiological studies have noted a link between menstrual intercourse and higher STI rates. In a large survey of women, researchers found a strong statistical association between having vaginal sex during menstruation and a history of STDs​. Notably, this correlation appeared even though the women who reported period sex were often from demographic groups with otherwise lower sexual risk – suggesting the act of intercourse during menses itself contributed to the elevated STD risk​. The investigators concluded that “sexual intercourse during menstruation may emerge as a risk factor for the transmission of HIV or other sexually transmitted pathogens,” recommending that public health efforts encourage abstinence during the menstrual period if further research confirms this risk​. In line with this, medical practitioners advise that if one chooses to have sex on a period, strict safe sex practices (condoms) are a must. Thomas Molinaro, MD (Obstetrics/Gynecology), notes that while period sex can be safe with protection, “there are a few studies that have shown an increased risk of contracting a sexually transmitted disease during menstruation, so it is advisable (as always) to practice safe sex.” This elevated risk is partly because the presence of blood allows blood-borne diseases to transfer more easily between partners. In simple terms, menstrual intercourse without protection is like removing a protective barrier – the blood can carry pathogens directly, and the slightly open cervix provides them a doorway.

It’s not only HIV or hepatitis; common STIs such as gonorrhea or chlamydia could also find an easier foothold. The acidic environment of the vagina (which normally helps kill or slow pathogens) is less acidic during menses (because menstrual blood has a neutral pH), and the immune cells in the vagina and cervix are in flux. In fact, some research suggests the female reproductive tract’s innate immune response is somewhat hampered during menstruation, which could reduce the natural defenses against infections​. Thus, exposure to an STI at that time might be more likely to lead to an actual infection.

Beyond STI transmission to the female partner, intercourse during menses can pose infection risks to the male partner as well. Bacterial or yeast overgrowth in the menstruating vagina can potentially affect the male. For instance, if a woman has a yeast infection or an imbalance during her period, intercourse can transmit yeast to the man, possibly causing balanitis (inflammation of the head of the penis)​. Although yeast infections are not life-threatening, this illustrates that the exchange of fluids during menstruation can spread organisms more freely in both directions. In summary, the menstrual phase is a time when exchanging bodily fluids carries extra hazards, and avoiding sexual contact then (as Qur’an 2:222 advises) corresponds to a prudent measure to reduce infection risks for both partners.

Vaginal Microbiome Changes and Hygiene Considerations

Modern gynecological science has revealed that the vaginal environment changes significantly during menstruation, in ways that can predispose to infections like bacterial vaginosis or other imbalances. Under healthy conditions, the vagina is populated by beneficial bacteria (primarily Lactobacillus species) that maintain an acidic pH and keep harmful microbes in check. During menstruation, however, that balance shifts: the influx of blood (which is relatively alkaline) raises vaginal pH and dilutes the lactobacilli. Studies using genomic sequencing of vaginal bacteria show that during menses the vaginal microbial diversity increases, while the Lactobacillus (good bacteria) counts drop. In other words, the protective bacteria are fewer, and a variety of other microbes (including anaerobic bacteria associated with bacterial vaginosis) grow more readily. Clinically, it’s observed that bacterial vaginosis (BV) tends to flare up around the time of menstruation. BV is an imbalance where harmful bacteria overgrow and cause discharge and odor; it’s not an STI per se, but sexual activity can trigger or worsen it. The Centers for Disease Control and Prevention (CDC) notes that “BV prevalence increases during menses,” and part of the reason is the change in pH and flora during bleeding.

Sexual intercourse during menstruation can exacerbate these microbial disturbances. Introducing semen (which is also alkaline) on top of menstrual blood can further raise the vaginal pH and disturb the ecosystem. Friction and intercourse may push bacteria that normally live in the vagina up closer to the cervix or even into the uterus. If a woman has BV or an unnoticed vaginal infection, intercourse during her period might spread those bacteria more deeply, potentially causing endometritis (infection of the uterine lining) or even pelvic inflammatory disease in severe cases. (Pelvic Inflammatory Disease, or PID, is an infection of the upper reproductive organs that can result from STIs like chlamydia/gonorrhea ascending into the uterus and tubes – a risk whenever such pathogens are introduced, and possibly facilitated by the menstrual opening of the cervix.) Although one review concluded that period sex by itself isn’t proven to increase PID risk in the absence of an STI​, it acknowledged that menstrual intercourse could contribute to transmitting infections that lead to PID. Essentially, if no harmful bacteria or viruses are present, one might get away with sex during menses without an immediate issue – but if any pathogen is introduced at this time, the vaginal hygiene defenses are compromised and the consequences can be more serious.

Medical advice for menstrual hygiene consistently emphasizes keeping the genital area clean and being cautious about introducing any foreign substances during periods. For example, douching (washing out the vagina) is strongly discouraged, especially during menstruation, because it can push bacteria upward and disturb the natural flora​. Intercourse similarly introduces foreign fluids and potentially bacteria at a time the vagina is trying to restore its normal balance. By refraining from intercourse during menstruation, a woman can focus on hygienic measures (regular changing of pads/tampons, washing externally with mild soap and water, etc.) without added challenges. Moreover, avoiding sex during this time spares both partners the potential “mess” and discomfort noted in medical literature – menstrual sex can be messy and cause anxiety about blood staining, which is a more minor issue but still a practical consideration​. From a medical standpoint, therefore, abstinence during menses can be seen as part of good menstrual hygiene practice, reducing exposure to infections and allowing the vaginal environment to recalibrate without interference.

Inflammation and Reproductive Health Implications

The Qur’anic verse refers to menstruation itself as “adha” – often translated as hurt, harm, or impurity. In a physiological sense, menstruation is indeed an inflammatory and strenuous process for the body. The uterus is contracting to expel tissue (sometimes causing cramping pain), the endometrial layer is breaking down (an inflammatory response), and there is an open exit through the cervix. Engaging in intercourse amid this ongoing process can contribute to additional mechanical stress and inflammation. For instance, intercourse can cause micro-tears or friction in vaginal tissues; normally these heal readily, but during menses the tissue is already inflamed and engorged, possibly making healing slower or pain more pronounced. Women who have sex during their period sometimes report greater discomfort or cramping afterward, likely due to the uterus reacting to stimulation while it’s already contracting to shed its lining.

Another aspect to consider is the temporary immune modulation that occurs during a woman’s cycle. As noted, innate immune activity in the vagina/cervix may be lower during menses​. Additionally, menstrual blood itself contains various cytokines (immune signaling molecules) and can provoke inflammation if introduced elsewhere. For the male partner, contact with menstrual fluids could, in rare cases, cause irritation or inflammation (some men experience balanitis or urethral irritation after exposure to menstrual blood, especially if either partner has poor genital hygiene or if the man is uncircumcised and retains bacteria under the foreskin). These inflammatory reactions are generally mild, but they reinforce the idea that menstrual intercourse does carry some inflammatory burden beyond that of regular sex.

Importantly, recent research has raised a potential link between menstrual intercourse and endometriosis, a gynecological condition where uterine lining tissue grows outside the uterus. The theory is as follows: during menstruation, some blood naturally flows backward through the fallopian tubes into the pelvic cavity (this is called retrograde menstruation and happens to many women without issue). If a woman has an orgasm or deep penetration during her period, the uterine contractions might increase the volume of backward flow or “push” menstrual debris in the wrong direction. This could potentially “seed” endometrial cells onto pelvic organs. In fact, some studies have found that women who routinely had sexual activity (especially orgasmic sex) during menses showed a higher incidence of endometriosis compared to those who abstained​. A 2022 systematic review concluded that “sexual activity during menstruation can be a predisposing risk factor for endometriosis,” advising that women be educated about this risk as a preventive measure. (It should be noted that endometriosis is multifactorial and not fully understood – not every woman who has sex on her period will get endometriosis, and one study even reported fewer instances of period sex among women who already have endometriosis​. However, the overall evidence leans toward a cautionary stance.) Given that endometriosis can cause chronic pain and fertility problems, any avoidable risk factor is taken seriously in gynecology. Avoiding intercourse during menstruation is a simple behavioral modification that, while not yet definitively proven to prevent endometriosis, is suggested by some experts as a prudent step, especially for women with other risk factors for the condition​.

Finally, consider reproductive tract healing and recuperation. After the menstrual phase, the endometrium rapidly repairs itself to build a fresh lining​. Intercourse during heavy bleeding could theoretically disturb this repair or introduce inflammation that complicates the regeneration. In clinical practice, a parallel is drawn with the postpartum period (after childbirth) – women are advised to avoid intercourse for about 6 weeks after delivery because the uterus is shedding lochia (blood and tissue) and is prone to infection while the cervix remains open. Menstruation is obviously a far less extreme scenario than postpartum, but it is similar on a smaller scale: the uterus is flushing out tissue and needs time to restore its lining without being exposed to outside pathogens. Thus, from an endometrial health standpoint, abstaining from sex until bleeding has ceased is logical, as it minimizes any chance of infection or irritation while the uterine lining is in a sensitive state.

Comparison with the Bible

Old Testament

In the Hebrew Bible, sexual intercourse during a woman’s menstrual period is explicitly forbidden. The Mosaic Law in Leviticus declares a menstruating woman “unclean” for seven days and prohibits a man from “uncovering her nakedness” (having sexual relations) during this time​ jwa.org. Such an act was not merely ritually defiling but considered a grave offense: Leviticus 20:18 warns that if a man lies with a woman during her menstruation, both of them “shall be cut off from among their people,” indicating severe punishment or expulsion​ jwa.org. This prohibition is reiterated in the prophets – for example, Ezekiel praises the righteous man who “does not approach a menstruating woman” and condemns those who do as committing a serious sin alongside crimes like murder and adultery ​jwa.org. In sum, the Old Testament frames sex during menstruation as strictly off-limits, associating it with ritual impurity and community sanction.

New Testament

By contrast, the New Testament contains no direct commands about menstruation or sexuality during menstruation. Nowhere do the Gospels or Epistles explicitly mention a woman’s period in relation to sexual activity, nor do they impose the Old Testament purity rules on Christian couples​ biblehub.com. Early Christian teaching shifted focus away from ritual uncleanness toward moral purity and mutual love in marriage. Thus, under the New Testament perspective, the Levitical menstrual prohibitions are generally not enforced – they are seen as part of the old ceremonial law that was fulfilled or rendered obsolete by Christ ​biblehub.com. In practice, this means the Bible’s later writings do not forbid marital relations during menstruation, leaving the matter to personal conscience rather than religious law.

Conclusion – Medical Wisdom Behind the Prohibition

When viewed through the lens of modern medicine, the Qur’anic injunction in 2:222 against intercourse during menstruation reveals a compelling alignment with health principles. Menstruation is indeed a time of “adha” or potential harm in the sense that the body is more vulnerable – the cervix is slightly open, the uterine lining is shedding (like a minor wound healing), and normal protective flora and immune defenses are reduced. Engaging in sexual intercourse under these conditions introduces clear risks: from a greater likelihood of contracting or spreading STIs to higher chances of disrupting the vaginal microbial balance (leading to issues like BV or yeast infections), and even possible long-term reproductive complications such as endometriosis. The table below summarizes the key medical concerns associated with intercourse during menstruation, which underscore the wisdom of avoiding sexual contact at that time:

• Higher STI Transmission Risk: Menstrual blood can carry viruses like HIV and hepatitis; exposure during sex facilitates blood-borne infection transfer​. Research shows period sex is statistically linked to higher STD rates, prompting some experts to call for abstinence during menses as a public health measure​.
• Disruption of Vaginal Flora: The vaginal environment becomes less acidic and Lactobacillus counts drop during menses, allowing harmful bacteria to grow​. Intercourse can push these bacteria further inside, increasing the risk of bacterial vaginosis and uterine infections​.
• Reduced Immune Protection: Natural immune responses in the vagina/uterus ebb during menstruation, meaning pathogens are more likely to establish an infection​. The already inflamed tissue can be further irritated by sex, potentially causing more inflammation or slower healing.
• Reproductive Tract Complications: Menstrual intercourse may contribute to retrograde flow of menstrual tissue, which studies suggest could raise the risk of endometriosis in susceptible women​. It also runs the risk of introducing infections that lead to pelvic inflammatory disease, a serious condition affecting fertility.

From these points, it is clear that abstaining from intercourse during menstruation is not only a religious directive but also a medically prudent practice. By avoiding sexual contact for those few days, individuals minimize exposure to infection at a vulnerable time and support the woman’s reproductive health and comfort. It’s remarkable that a 7th-century religious text would touch on a guideline that aligns closely with current medical advice for reducing gynecologic health risks. While people today have the benefit of scientific studies and clinical data, the ancient rule in Qur’an 2:222 anticipated a protective measure that science now affirms as sensible. In an academic context, this convergence between scripture and science can be seen as an example of traditional wisdom being borne out by modern evidence. The human body during menstruation is telling us it needs caution and care – and the Qur’anic injunction effectively enshrines that understanding. Thus, the prohibition of intercourse during menstruation reflects a profound concern for women’s health and well-being, one that contemporary medicine fully appreciates and validates with empirical findings.

Sources: Recent medical literature and clinical guidelines have been used to support this commentary. Key references include CDC sexual health guidelines on vaginal infections​ cdc.gov, peer-reviewed studies on STI risks and menstrual intercourse​ pubmed.ncbi.nlm.nih.gov, research on vaginal microbiome changes during the menstrual cycle​ pmc.ncbi.nlm.nih.gov, and a 2022 systematic review on menstrual sex and endometriosis risk​ pmc.ncbi.nlm.nih.gov, among others. These evidence-based insights illustrate the biological rationale behind avoiding intercourse in menses, highlighting the convergence of Qur’anic guidance with modern health knowledge. Each citation provided corresponds to a specific study or source that corroborates the statements made, ensuring the commentary remains factual and scientifically grounded.