A dilation and curettage, also called a D & C or D and C, is a minor surgery that involves dilating or opening the cervix. The cervix is the opening to your uterus or womb. After dilating your cervix, your doctor uses a spoon-shaped object called a curette to remove tissue from the inner lining of your uterus.
The procedure occurs 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 this procedure. The most common are:
- to determine the reason for heavy bleeding during or between your menstrual periods
- to remove noncancerous tumors, or fibroids
- to remove and examine potentially cancerous tumors
- to remove infected tissue, which is often caused by a sexually transmitted disease called pelvic inflammatory disease (PID)
- to remove tissue left behind in the womb after miscarriage or childbirth
- to perform an elective abortion
- to 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 their instructions exactly. Some things you might need to do include the following:
- Avoid eating or drinking the day of the surgery.
- Get a physical exam to make sure you’re healthy enough for the procedure.
- Visit your doctor the day before so they can apply a gel to start the process of opening your cervix.
- Arrange to take one or two days off 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. With a general anesthetic, you’ll receive medicine through an intravenous line (IV) into a vein in your arm. This causes you to sleep deeply throughout the procedure. A general anesthetic is an option only in a hospital or day surgery setting.
Spinal anesthesia, also called a spinal block, involves injecting anesthetic into your spinal cord. You’ll remain awake for the procedure, but you won’t be able to feel anything below the injection site. As with general anesthetic, a spinal block is typically used only 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 won’t be in any pain when your doctor dilates your cervix. However, you may experience some cramping in your uterus when the doctor removes the lining with a curette. A local anesthetic is an option in your doctor’s office or a clinic.
If you’re anxious about your D and C, ask your doctor if they can sedate you throughout the procedure. This may involve taking a pill for anxiety, or it may involve injecting medication through an IV. You’ll be in a light sleep during the procedure and will remember almost nothing about it afterward if you receive IV sedation.
When you arrive, a nurse or a technician will ask you to remove your clothing and put on a hospital gown. If you’re receiving general anesthetic or IV sedation, a nurse will insert a small plastic catheter into a vein. They’ll also hook you up to monitors that painlessly measure your blood pressure, breathing, and heartbeat.
When your doctor is ready to start the procedure, they’ll ask you to lie back on an examination table as you would if you were having a Pap test. You’ll rest your feet in stirrups, and a sheet or 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:
- Your doctor inserts a device called a speculum to spread your vaginal walls so that they can see the cervix.
- Your doctor dilates the cervix by inserting a series of rods into your cervical opening. Each rod is a little thicker than the one before it.
- After dilating the cervix, your doctor inserts a spoon-shaped device called a curette, and draws the sides of the device along the lining of the uterus.
- If the curette can’t loosen all the tissue, your doctor may use a suction device as well. If you’ve had a local anesthetic, you’ll probably notice some cramping.
- After removing the material from your uterus, your doctor removes the instruments from your body.
- Your doctor then sends the material removed from the uterus to a laboratory for analysis.
This is a very low-risk procedure because it’s minimally invasive. However, any surgical procedure has some potential dangers. These may include:
- anesthesia-related problems with the heart and lungs, which are rare
- blood clots related to staying in bed and not moving around, which are rare if you follow your doctor’s instructions about getting up regularly
- damage to the uterus or cervix
These may be a sign of damage to your uterus or cervix:
Go to your doctor or an emergency room immediately if you experience any of these symptoms.
It’s common to feel tired and experience light cramps for a day or two after the procedure. You’ll remain in the facility a short time for observation. You won’t be able to drive immediately after the procedure. Arrange for a friend or 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. Don’t use a tampon because it could cause an infection. You may notice cramping for a few days. If your doctor doesn’t prescribe pain medication, ask them 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 help prevent blood clots from forming in your legs.
You should be able to resume most of your routine within a day or two after the procedure. However, your doctor will ask you to refrain from taking a bath, douching, or having intercourse for at least three days and possibly longer.
If your doctor removes potentially cancerous tumors or materials, you’ll get a report from your doctor’s office on the laboratory findings. If the results are benign (noncancerous), you may not need a follow-up. If the results show cancerous or precancerous cells, your doctor will probably refer you to a specialist to talk about your next steps.