Dilation and Curettage (D & C)

What is dilation and curettage (D&C)?

Dilation and curettage, often called a D&C, is a minor surgical procedure done to remove tissue from a woman’s uterus (womb). It is usually an outpatient surgery that can be done in a doctor’s office or surgery center. It is performed by a gynecologist or obstetrician.

The name refers to the dilation of the cervix, into which a thin instrument called a curette is inserted. The cervix is the narrow opening of the uterus that joins with the top of the vagina. It usually only dilates (opens) naturally during childbirth.

Who needs a dilation and curettage (D&C)?

A D&C may be necessary if a woman has had a miscarriage, has leftover tissue from an abortion in her uterus, or has unexplained bleeding between menstrual periods.

A D&C may also be done along with a procedure called a hysteroscopy. In this procedure, a device is inserted to view the inside of the uterus for diagnostic purposes.

How is a dilation and curettage (D&C) performed?

Your gynecologist or obstetrician will usually begin a D&C by giving you medication to relax or partially sedate you. The procedure is not usually performed under full anesthesia, but in rare circumstances or at your request it may be done. The procedure will usually cause cramping similar to menstrual cramps. You may be given pain medication to deal with these cramps.

Your doctor may begin to dilate your cervix by using something called a laminaria stick before surgery. This is a thin rod that is inserted into the cervix and left in place for several hours. The rod absorbs fluids from the cervix, causing it to open, or dilate, and provide access to your uterus. Your doctor may also give you medications to help soften and numb your cervix.

Much like a gynecological exam, a D&C is performed with your back on a table and your feet in stirrups. A speculum will be inserted into your vagina. Your cervix will be held in place with a clamp.

Once your cervix is sufficiently dilated – about one-half inch in diameter – your doctor will use a suction device or a scraping instrument, called a curette, to clean out tissue from the uterus.

In most cases, your doctor will a take sample of the tissue for laboratory analysis following the procedure.

What are the risks of dilation and curettage (D&C)?

A D&C is a very routine, safe procedure. But like all surgical procedures, there is the rare risk of complication. In the case of a D&C, risks include uterine perforation and infection. In rare cases, after a D&C has been performed following a miscarriage, adhesions may form in the uterus. This is called Asherman syndrome. The scar tissue can cause infertility and changes in menstrual flow, but can usually be treated successfully with surgery.

Most complications from a D&C are treatable, especially infection, if diagnosed early. If you notice any of the following after a D&C, you should contact your doctor immediately:

• Unusual or foul-smelling discharge
• Abdominal pain
• Excessive bleeding
• Excessive cramping
• Fever

What is the follow-up care for a dilation and curettage (D&C)?

You should be able to go home within a few hours after a D&C. Mild pain or light bleeding is normal for a few days. Within a few days, you should be able to resume most of your regular activities.

After a D&C, your next menstrual period may be early or late. Your doctor will advise you not to use tampons or have intercourse for a while after the procedure. Until your cervix returns to normal, you will be at higher risk of bacteria entering the vagina and causing infection.