Are you going in for a dilation and curettage and not sure what to expect?
There are many reasons why you might need to have this surgical procedure.
It can be daunting and even worrying as you try to decide whether it’s the best option.
Let’s start by understanding exactly what happens and why it’s done.
Dilation and curettage definition
The name actually explains it perfectly.
It’s a surgical procedure where your cervix is dilated to allow the passage of an instrument called a curette.
‘Curette’ is a French word for an implement designed to scrape or scoop.
Curettage is literally the scraping away of tissue from inside your uterus.
Dilation and curettage indications
Your doctor might perform the procedure for both diagnostic and treatment reasons.
- Find the cause of abnormal or excessive bleeding
- Investigate infertility problems
- Detect disease and abnormalities of the uterus
- Treat heavy bleeding
- Clear the uterine lining after a miscarriage or abortion
- Remove tissue (retained placenta or membranes after birth)
Abnormal uterine bleeding can be caused by abnormal uterine tissue such as fibroids or polyps. Depending on their size, they can be scraped away during the procedure.
Miscarriage or pregnancy loss can cause heavy bleeding as the pregnancy tissue is passed. A dilation and curettage is recommended if any tissue remains, or if there are signs of infection.
Abnormal uterine bleeding can follow childbirth if pieces of the placenta or membranes aren’t passed. This is sometimes known as a retained placenta. They prevent the uterus from healing and contracting back to normal and can become infected if they aren’t removed.
Hormonal imbalances and disorders, especially during perimenopause or post-menopause, can also cause abnormal bleeding.
Dilation and curettage procedure
Your doctor might treat you as an outpatient, or during your hospital stay.
What will happen:
- During the admission process, your ob-gyn explains the procedure, including possible complications and side effects, and you sign the consent form.
- An intravenous (IV) line is started in your arm for the administration of the general anesthetic, or IV fluids if you’re having a local or regional (epidural) anesthetic.
- You’re positioned on an operating bed, lying on your back with your legs supported, as for a pelvic examination.
- A urinary catheter is inserted, to ensure your bladder stays empty during the procedure.
- A speculum is used to open the vagina and expose the cervix for easy access.
- Your cervix is cleansed with an antiseptic solution and gradually dilated (opened) using a series of thin metal rods.
- The curette (long spoon-shaped instrument) is passed through your dilated cervix and moved around the lining of your uterus to remove tissue.
- Any tissue collected during the procedure is sent to the lab for testing.
- All instruments are removed and you are cleaned.
- You are moved to the recovery area and monitored for a few hours, before being discharged and going home.
Are you sedated for a dilation and curettage?
There are different levels of sedation and anesthesia used for minor procedures. Sedation is considered a lighter form of anesthetic.
For dilation and curettage, some level of sedation is always used. The type used depends on your personal choice, as well as the indications for the procedure and your medical history and health profile.
Types of sedation:
- Deep sedation: General anesthesia uses a combination of intravenous (IV) drugs and inhaled gases to put you into a sleep-like state. You’re unconscious and won’t feel any pain.
- Moderate sedation: Regional anesthesia uses a local anesthetic injection to numb a large part of your body. In this case, the lower part of your body will be numbed. You’ll be awake during the procedure, but you might be given a light sedative injection to help you relax.
- Light sedation: Local anesthetic involves an injection of a numbing agent directly into the area being operated on. You’ll be awake during the procedure and might be given a light sedative to help you relax.
For local anesthesia, the doctor might numb the area using a small needle to inject the medication.
If general or regional anesthesia is used, the anesthesiologist continuously monitors your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
How long do dilation and curettage take?
The actual procedure usually takes only 10 to 15 minutes.
Depending on the sedation used, the reason for the surgery, and where you had it performed, you might need to stay in the doctor’s office, clinic, or hospital for several hours.
Is dilation and curettage painful?
It’s normal to have some mild cramping and pain after having the procedure. Most women compare the discomfort with menstrual cramps.
Take a pain reliever for cramping or soreness as recommended by your doctor. Aspirin or certain other pain medications could cause bleeding. Be sure to take only medications recommended by your doctor.
If you have a fever, severe pain, and cramping, or any other concerns, see your doctor for a follow-up appointment as soon as possible.
How long does it take to recover from dilation and curettage?
The recovery process varies depending on the type of surgery performed and the type of anesthesia administered.
If you had regional or general anesthesia, when your blood pressure, pulse, and breathing are stable and you are alert, you’ll be taken to your hospital room or discharged.
After having local anesthesia, usually you may go home after resting for about two hours.
After a dilation and curettage, you’ll be instructed not to douche, use tampons, or have intercourse for two to three days, or for a period of time recommended by your doctor.
The doctor might also advise you about other restrictions, including no strenuous activity or heavy lifting.
Typically you’ll need to rest for 2-3 days after the procedure before resuming normal activities.
Bleeding after dilation and curettage
It’s normal to have some spotting or light bleeding for a few days or a week after the procedure. You can use a sanitary pad, but don’t use tampons.
Depending on the reason for the dilation and curettage, your doctor will tell you what to expect in terms of bleeding afterward, and when to return for further treatment or care.
Notify your doctor if you experience any of the following:
- Severe bleeding
- Foul-smelling discharge from your vagina
- Fever and/or chills
- Severe abdominal pain.
Hysteroscopy and dilation and curettage
Hysteroscopy allows your doctor to do a visual examination of the inside of your uterus. It can be performed for diagnostic or therapeutic reasons.
By inserting a lighted tube with a camera through the cervix and into the uterus, the doctor is able to find abnormalities or retained tissue after a miscarriage, for example.
Do dilation and curettage affect fertility?
The procedure should not affect your chances of becoming pregnant in the future.
There’s a very small risk of scar tissue developing in the cervix or uterus after a dilation and curettage procedure is performed for:
- Elective termination of pregnancy
- Missed or incomplete miscarriage
- Treating a retained placenta after birth.
Scar tissue forming like this is called Asherman’s syndrome. The reason you needed a dilation and curettage will determine the effect on your menstrual cycle.
If you plan to get pregnant after the procedure, talk to your health care professional about your options, and about how long you should wait.
Is dilation and curettage an abortion?
Surgical abortion using dilation and curettage is likely to be performed to limit the risk of severe bleeding afterward.
It’s done between 6 and 14 weeks and involves a hollow tube being inserted into the uterus after the cervix is dilated.
The tube is attached to a machine that has an action similar to a vacuum; it sucks out the contents of the uterus. The doctor then gently scrapes the lining of the uterus with the curette to make sure nothing remains.
Complications of dilation and curettage
Like any medical procedure, there are some risks involved in dilation and curettage. You should weigh the risks against the reason for having the procedure, so you can make an informed choice about what’s best for you.
- Heavy bleeding
- Infection of the uterus
- Perforation of the uterus
- Perforation of the bowel (next to the uterus)
- Problems related to the anesthesia used (rare)
- Scar tissue or adhesions developing inside the uterus or cervix.