Dilation and Curettage
Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.
In a dilation and curettage — sometimes spelled “dilatation” and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction.
D&C is used to diagnose and treat many conditions that affect the uterus, such as abnormal bleeding. A D&C also may be done after a miscarriage. A sample of tissue from inside the uterus can be viewed under a microscope to tell whether any cells are abnormal. 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.
Before the procedure:
- Follow your doctor’s instructions on limiting food and drink.
- Arrange for someone to help you get home because you may be drowsy after the anesthesia wears off.
- Clear your schedule to allow enough time for the procedure and recovery afterward. You’ll likely spend a few hours in recovery after the procedure.
To promote dilation, your doctor uses a medication called misoprostol (Cytotec) — given orally or vaginally — to soften the cervix or inserts a slender rod made of laminaria into your cervix. The laminaria gradually expands by absorbing the fluid in your cervix, causing your cervix to open.
For dilation and curettage, you’ll receive anesthesia. The choice of anesthesia depends on the reason for the D&C and your medical history.
General anesthesia makes you unconscious and unable to feel pain. Other forms of anesthesia provide light sedation or use injections to numb only a small area (local anesthesia) or a larger region (regional anesthesia) of your body.
- You lie on your back on an exam table while your heels rest in supports called stirrups.
- Your doctor inserts an instrument called a speculum into your vagina, as during a Pap test, in order to see your cervix.
- Your doctor inserts a series of thicker and thicker rods into your cervix to slowly dilate your cervix until it’s adequately opened.
- Your doctor removes the dilation rods and inserts a spoon-shaped instrument with a sharp edge or a suction device and removes uterine tissue.
Because you’re either unconscious or sedated during a D&C, you shouldn’t feel any discomfort.
You may spend a few hours in a recovery room after the D&C so that your doctor can monitor you for heavy bleeding or other complications. This also gives you time to recover from the effects of anesthesia.
If you had general anesthesia, you may become nauseated or vomit, or you might have a sore throat if a tube was placed in your windpipe to help you breathe. With general anesthesia or light sedation, you may also feel drowsy for several hours. Normal side effects of a D&C may last a few days and include:
- Mild cramping
- Spotting or light bleeding
You should be able to resume your normal activities within a day or two.
Wait to put anything in your vagina until your cervix returns to normal to prevent bacteria from entering your uterus, possibly causing an infection. Ask your doctor when you can use tampons and resume sexual activity.
Your uterus must build a new lining after a D&C, so your next period may not come on time. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your doctor about when it’s safe to start trying again.
Dilation and curettage is usually very safe, and complications are rare. However, there are risks. These include:
- Perforation of the uterus. Perforation of the uterus occurs when a surgical instrument pokes a hole in the uterus. This happens more often in women who were recently pregnant and in women who have gone through menopause. Most perforations heal on their own. However, if a blood vessel or other organ is damaged, a second procedure may be necessary to repair it.
- Damage to the cervix. If the cervix is torn during the D&C, your doctor can apply pressure or medicine to stop the bleeding, or can close the wound with stitches (sutures).
- Scar tissue on the uterine wall. Rarely, a D&C results in development of scar tissue in the uterus, a condition known as Asherman’s syndrome. Asherman’s syndrome happens most often when the D&C is done after a miscarriage or delivery. This can lead to abnormal, absent or painful menstrual cycles, future miscarriages and infertility.
- Infection. Infection after a D&C is possible, but rare.
- Bleeding that’s heavy enough that you need to change pads every hour
- Cramps lasting more than 48 hours
- Pain that gets worse instead of better
- Foul-smelling discharge from the vagina