Dilation and Curettage

Dilation and curettage (D&C) is a surgical procedure that is used to diagnose and treat many conditions that after the uterus. Dilation means to open the cervix so that a thin instrument can be introduced into the uterus for the procedure. Curettage involves removing tissue from the inside of the uterus.

This pamphlet explains:

• reasons a D&C may be done
• what to expect during the procedure
• risks of the procedure
• recovery

Reasons for a D&C

A D&C may be done to find out the cause of abnormal bleeding. It provides a sample of the tissue that lines the uterus. This sample can be viewed under a microscope to tell whether any cells are abnormal. A D&C also may be done after a miscarriage or abortion to remove tissue that has remained in the uterus. A D&C may be done with other procedures, such as hysteroscopy, in which a slender device is used to view the inside of the uterus.

The D&C Procedure

A D&C can be done in a health care provider’s office, a surgery center, or a hospital. Your health care provider may want to start dilating your cervix before surgery using laminaria. This is a slender rod of natural or synthetic material that is inserted into the cervix. It is left in place for several hours. The rod absorbs fluid from the cervix and expands. This causes the cervix to open. Medication also may be used to soften the cervix, making it easier to dilate.

Before or during your D&C, you may receive some type of anesthesia. You and your health care provider will discuss the type to be used. With general anesthesia, you will not be awake during the procedure. You will receive medication either through an intravenous line or a mask. With regional anesthesia, you will be awake. Often you will have medication to make you drowsy.

During the procedure, you will lie on your back and your legs will be placed in stirrups. A speculum will be inserted into your vagina. The cervix will be held in place with a special instrument.

The cervix will then be slowly opened (dilated). This is done by inserting a series of rods that become progressively larger through the cervical opening. Usually only a small amount of dilation is needed (less than one half inch in diameter).

Tissue lining the uterus will be removed, either with an instrument called a curette or with suction. In most cases, the tissue then will be sent to a laboratory for examination.

Risks

Complications are rare. When they do occur, they include bleeding, infection, or perforation of the uterus (when the tip of an instrument passes through the wall of the uterus). If perforation occurs, nearby organs may be damaged and further surgery may be required. Problems related to the anesthesia used also can occur.

In rare cases, after a D&C has been performed after a miscarriage, bands of scar tissue, or adhesions, may form inside the uterus. This is called Asherman syndrome. These adhesions may cause infertility and changes in menstrual flow. In most women, Asherman syndrome can be treated successfully with surgery. Call your health care provider if you notice changes in your menstrual periods after a D&C procedure.

Recovery

After the procedure, you probably will be able to go home within a few hours. You will need someone to take you home. You should be able to resume most of your regular activities in 1 or 2 days.

If you had general anesthesia, you may have some nausea and vomiting when you wake up. You may feel groggy and weak for a short while. You may have a sore throat from the tube that was inserted into your windpipe to help you breathe.

Pain after a D&C usually is mild. You may have spotting or light bleeding. You should contact your health care provider if you have any of the following:

• Heavy bleeding from the vagina
• Fever
• Pain in the abdomen
• Foul-smelling discharge from the vagina

After a D&C, a new lining will build up in the uterus. Your next menstrual period may not occur at the regular time. It may be early or late.

Until your cervix returns to its normal size, bacteria from the vagina can enter the uterus and cause infection. It is important not to put anything into your vagina after the procedure. Ask your health care provider when you can have sex or use tampons again.

Your health care provider will ask that you make an appointment to see him or her soon after your D&C to discuss the results. If further treatment is needed, your health care provider will discuss it with you.

Finally…

A D&C is done to find the cause of abnormal uterine bleeding or to remove tissue after a miscarriage or abortion. The recovery period usually is short. If you have questions about the procedure, discuss them with your health care provider.

Glossary

Adhesions: Scarring that binds together the surfaces of tissues.

Anesthesia: Relief of pain by loss of sensation.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervix: The opening of the uterus at the top of the vagina.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Hysteroscopy: A procedure in which a device called a hysteroscope is inserted through the cervix and vagina into the uterus. The hysteroscope is used to view the inside of the uterus or perform surgery.

Laminaria: A slender rod made of natural or synthetic material that expands when it absorbs water; it is inserted into the opening of the cervix to widen it.

Miscarriage: Early pregnancy loss.

Regional Anesthesia: The use of drugs that prevent pain in a region of the body.

Speculum: An instrument used to hold open the walls of the vagina.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.