A “D and C,” also written as “D & C,” is short for “dilation and curettage,” which is a minor surgery. It involves dilating or opening the cervix. The cervix is the opening to your uterus or womb. Once the cervix is dilated, a doctor uses a spoon-shaped object called a curette to remove tissue from the inner lining of the uterus.
A D and C can is performed in a doctor’s office, a women’s health clinic, a day surgery center, or a hospital.
There are many reasons that a doctor might order a D and C. The most common purposes of the procedure are to:
- determine the reason for heavy bleeding during or between your menstrual periods
- remove non-cancerous tumors, or fibroids
- remove and examine potentially cancerous tumors
- remove infected tissue (often related to a sexually transmitted disease called pelvic inflammatory disease, or PID)
- remove tissue left behind in the womb after a miscarriage
- perform an elective abortion
- remove an intrauterine device (IUD), which is a form of birth control
Your doctor will give you written instructions on preparing for your D and C. Always follow his or her orders exactly. Some things you might be instructed to do include:
- Avoid eating or drinking the day of the surgery.
- Undergo a physical exam to make sure you are healthy enough to withstand the procedure.
- Visit the doctor the day before so he or she can apply a gel to start the process of opening your cervix.
- Arrange to take off one or two days from work or school.
- Make sure you have someone to drive you home after the procedure.
You and your doctor have many choices when it comes to anesthetics. A general anesthetic means that you will receive medicine through an IV in your arm that causes you to sleep deeply throughout the procedure. General anesthetic is used only in a hospital or day surgery setting.
Spinal anesthesia, also called regional anesthesia, involves injecting anesthetic into your spinal cord. You will remain awake for the procedure, but you will not be able to feel anything below the area that was blocked. As with general anesthetic, a spinal block is typically used in hospitals and day surgery centers.
A local anesthetic means that the doctor will inject an anesthetic directly into your cervix. You may feel a pinch and a sting with the injection. Once your cervix is numb, you will not be in any pain when the doctor dilates the cervix. However, you may experience some cramping in your uterus when the doctor removes the lining with a curette. A local anesthetic can be used in your doctor’s office or a clinic.
If you are anxious about your D and C, ask your doctor if you can be sedated throughout the procedure. This may involve taking a pill for anxiety, or it may involve medication being injected through an IV. If you receive IV sedation, you will be in a light sleep during the procedure and will remember almost nothing about it afterward.
When you arrive, a nurse or a technician will ask you to remove your clothing and put on a hospital gown. If you will be receiving general anesthetic or IV sedation, a nurse will insert a hollow needle into a vein. He or she will also hook you up to monitors that painlessly measure your blood pressure, breathing, and heartbeat.
When the doctor is ready to start the procedure, he or she will ask you to lie back on an examination table as you would if you were having a Pap smear. Your feet will rest comfortably in stirrups and a sheet or a blanket will cover your knees. Usually, one nurse is present to help the doctor and another is available to monitor your vital signs and provide support and reassurance.
The operation will proceed as follows:
- The doctor will insert a device called a speculum to spread your vaginal walls so that he or she can see the cervix.
- The doctor will dilate the cervix by inserting a series of rods—each a little thicker than the one before it—into the cervical opening.
- When the cervix is dilated, the doctor will insert a spoon-shaped device called a curette, and draw the sides of the device along the lining of the uterus.
- If the curette can’t loosen the tissue that needs to be removed, the doctor may use a suction device as well. If you have had a local anesthetic, you will probably notice some cramping.
- When all of the material has been removed from the uterus, your doctor will remove the instruments from your body.
- The material removed from the uterus will be sent to a laboratory for analysis.
You will be asked to remain in the facility a short time for observation. You will not be able to drive immediately after your D and C. Arrange for a friend or a family member to take you home.
Light bleeding is common after a D and C, so you’ll probably want to wear a menstrual pad. Do not use a tampon, as it could irritate your vagina. You may notice cramping for a few days. If your doctor doesn’t prescribe pain medication, ask him or her which over-the-counter brand will best help with your discomfort.
Even if it’s uncomfortable, get up and move around as soon as possible. This will keep your muscles strong and will prevent blood clots from forming in your legs.
Your physician will ask you to refrain from taking a bath, douching, or having intercourse for a period of at least three days and possibly longer. You should be able to resume your regular routine within a day or two after the procedure.
A D and C is considered a very low-risk procedure, as it is minimally invasive. However, any surgical procedure has some potential dangers. These may include:
- anesthesia-related problems with the heart and lungs (rare)
- blood clots related to staying in bed and not moving around (rare if you follow your doctor’s instructions about getting up regularly)
- damage to the uterus or cervix that may result in heavy bleeding, foul-smelling discharge, severe pain, fever, and chills. If you experience any of these symptoms, get to your doctor or an emergency room immediately.
Most commonly, however, you’ll feel tired and experience light cramps for a day or two.
You will receive a report from your doctor’s office on the laboratory findings. If they are benign (non-cancerous), you may not need additional follow-up. If they show cancerous or pre-cancerous cells, your doctor will probably refer you to a gynecologist who is also a cancer specialist to talk about your next steps.