Dilation and Curettage (D&C), Diagnostic

What is diagnostic dilation and curettage?

Diagnostic dilation and curettage (D&C) is a minor surgical procedure used to get a sample of tissue from the lining of the uterus (the endometrium). The uterus is the organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

Dilatation is performed to open and widen the cervix (entrance to the uterus). Curettage is used to sample the lining of the uterus. The tissue sample is sent to the lab for tests.

When is it used?

This procedure is used to look for the cause of unusual uterine bleeding, recurrent pelvic pain, or enlargement of the uterus.

In some cases alternatives to this procedure may be:

• endometrial biopsy (a sample of the inner layer of the uterine wall is removed using a tiny strawlike tube)
• hysteroscopy (dilating the cervix and using a scope to look at the inside of the uterus).

Another alternative is to choose not to have any procedure, recognizing the possible risks of your condition. You should ask your health care provider about these choices.

How do I prepare for a D&C?

Plan for your care and recovery after the procedure. Allow for time to rest. Try to find people to help you with your day-to-day duties.

Follow instructions provided by your health care provider. No special preparation is needed for regional anesthesia. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water. Arrange to have someone take you home and stay with you for a while after the procedure.

What happens during the procedure?

You are given a sedative or a regional or general anesthetic. A sedative helps you relax. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles and causes a deep sleep. It will prevent you from feeling pain during the procedure.

Your health care provider stretches open (dilates) your cervix and guides a scooplike instrument (a curette) into the uterus. Your provider uses the curette to lightly scrape the lining of the uterus to get a piece of it. Your health care provider may use a scope during the D&C to get samples of tissue from specific sites in the uterus. The tissue will be sent to the lab for tests.

What happens after the procedure?

If there are no complications, you may go home a few hours after the procedure. Expect some bleeding and menstrual-type cramps for the first day or so. Your health care provider may suggest a pain medicine to relieve the discomfort. Women who are still having periods usually have their next period 2 to 6 weeks after the D&C.

Do not place anything inside the vagina, including tampons, and do not have sexual intercourse until your provider says it is safe.

Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

The procedure may help your health care provider arrive at a better diagnosis. In addition, depending on the diagnosis, the scraping of the uterine lining may help treat your problem.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your health care provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases regional anesthesia is considered safer than general anesthesia.
• The uterus may be hurt or punctured (perforated) by the curette and require surgery.
• The walls of the uterus may bleed more after the procedure than before the procedure.
• There is a small chance the uterus will become infected as a result of this procedure.

You should ask your health care provider how these risks apply to you.

When should I call my health care provider?

Call your provider right away if:

• You have heavy bleeding from the uterus (you need more than 1 pad or tampon per hour or the bleeding is heavier than your normal menstrual flow).
• You develop a fever over 100°F (37.8°C).
• You have severe abdominal pain or abdominal pain that continues even after you take acetaminophen or aspirin.
• You have a foul-smelling discharge from the vagina.

Call your health care provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.