Dilation and Curettage (D&C)
This page describes the dilation and curettage (D&C) procedure in detail and could be upsetting for some women. If women wish to stop reading at this point, they should refer all questions to their HCP.
D&C is the most common surgical procedure performed throughout the world routinely by many obstetricians and gynecologists.
The procedure is also used as a diagnostic tool in which tissue can be removed and examined in the case of fibroids, polyps, abnormal pap smear, endometriosis, miscarriage, and to determine a cause of bleeding between cycles or after menopause. D&Cs are considered very safe and effective and complications are rare.
A D&C can be done in an HCP's office, a surgery center, or a hospital, depending on how its completed and the type of anesthesia used.
The choice of anesthesia given for the procedure is dependent on the HCP, practice or health center, and the woman’s medical history. Anesthesia options include regional (spinal/epidural), or general (full) anesthesia. The type of anesthesia usually determines where the procedure is performed. The type will also determine whether eating is allowed before the procedure; women may be asked not to eat anything up to 8 hours beforehand.
With a woman lying down on her back and her feet up, the HCP will numb the cervix with an anesthetic and enter a speculum into the vagina – the same as a pelvic exam.
A speculum is used to hold the walls of the vagina open so the HCP can view the cervix. A speculum can either be metal or plastic (clear).
During the procedure, the HCP is exploring a body cavity in which they cannot see, known as a blind procedure. The procedure’s success is almost completely dependent on the experience of the HCP and their comfort in utilizing different instruments. The HCP can view the external part of the vagina, the vaginal canal, and the external os of the cervix – the same structure that is swabbed during pap smears.
The first part of the actual procedure requires dilation. Dilation is usually completed immediately prior to the D&C, but some HCPs may start dilation several hours to a day before. Dilation is completed using either medication or very thin, slender rods of synthetic material called laminaria.
The rods absorb cervical fluid, which expands the rod, and therefore slowly dilates the cervix. Only a very small amount of dilation is necessary, usually 1 cm.
The HCP will remove the rods and insert a curette – a spoon-shaped instrument with a sharp edge or suction device – and remove uterine tissue. Curettes can be firm, flexible, sharp, or use suction. A small camera may also be used to take internal pictures if necessary.
The removed tissue may be sent to a laboratory for additional evaluation under a microscope. An ultrasound may guide the procedure and may also be used afterward to help assess if all tissue has been removed.
Risks and Complications
Although unlikely, some of the possible complications of the procedure include risks of general anesthesia, reaction to medications, cervical damage, puncture or perforation of the uterine wall (higher risk in “tilted” uterus), hemorrhage, infection of the uterus or other pelvic organs, scar tissue within the uterus, adhesions (Asherman’s syndrome), uterine fistulae, possible negative effects on future pregnancies (debated), and death (as is the risk for any surgical procedure).
Women are advised to call their HCP or seek immediate care with any unusual or odorous discharge, chest pain, abdominal pain, shortness of breath, excessive bleeding, excessive cramping, and/or fever.
After a few hours in recovery, most women can go home if no complications are present. Normal activities can usually begin in a day or two. Women should rest and have someone take them home, especially if general anesthesia was used.
Heat compresses are advised as well as acetaminophen (Tylenol®) or ibuprofen (Advil®) for controlling pain, which is usually mild. Some women may also be given antibiotics. Bleeding is usually light, as most of the lining has been removed, but spotting is possible for a few days. Tampons are not recommended, as anything in the vagina while the cervix is closing could cause infection.
After a D&C, a new lining will build up in the uterus, similarly to after menstruation; a woman’s normal cycle may arrive earlier or later than expected.
If women wish to try to conceive again as soon as possible, they should talk to their HCP about when it is considered safe to do so.
Women should write down all the questions they have and ask them during the appointment scheduled prior to the procedure.
Women should never undergo a procedure in which they are not comfortable, or in which they do not believe they have all the information regarding the risks and benefits compared to their other options. Women have several options for the management of miscarriage (read more here).
After the procedure, women are advised to call their HCP or seek immediate care with any unusual or odorous discharge, chest pain, abdominal pain, shortness of breath, excessive bleeding, excessive cramping, and/or fever.