A D&C, short for dilation and curettage, is a gynecological procedure that removes tissue from inside the uterus. It’s one of the most common procedures in women’s health, performed either to diagnose conditions like abnormal bleeding or to treat issues like a miscarriage. The procedure involves two steps: gently opening the cervix, then using a small instrument to remove uterine tissue.
Why a D&C Is Performed
D&Cs fall into two broad categories: diagnostic and therapeutic. A diagnostic D&C collects a sample of the uterine lining so it can be examined under a microscope. This is commonly done to investigate unexplained uterine bleeding, to check for precancerous changes, or to screen for endometrial cancer. When used for cancer detection, a D&C correctly identifies about 77 out of 100 cases of endometrial cancer and correctly rules it out in 99 out of 100 people who don’t have it.
A therapeutic D&C treats a problem rather than just diagnosing one. The most common therapeutic use is managing a miscarriage, either by removing tissue that the body hasn’t passed on its own or by treating incomplete miscarriage where some tissue remains. D&Cs are also used to remove uterine polyps, to treat excessive bleeding, and as part of pregnancy termination.
What Happens During the Procedure
The “D” comes first. Your doctor uses a speculum (the same tool used during a Pap test) to hold the vaginal walls apart, then gradually opens your cervix by inserting a series of thin rods that increase in thickness. In some cases, your cervix may be softened ahead of time with medication or a thin rod placed hours or even a day before the procedure, particularly if the cervix needs to open wider than usual.
Once the cervix is open, the “C” begins. Your doctor inserts a curette, a long, thin instrument, through the cervix and into the uterus. Depending on the reason for the procedure, this instrument may be a small spoon-shaped tool with a sharp edge or a plastic tube attached to suction. The curette is moved systematically along the uterine walls in a rotating pattern to remove tissue from the entire lining.
Sharp Curettage vs. Suction
For diagnostic purposes, a sharp metal curette is typically used to scrape and collect tissue samples. For miscarriage management, suction-based methods are now preferred. The World Health Organization and the International Federation of Gynecology and Obstetrics both recommend suction over sharp curettage for treating first-trimester miscarriage, because the plastic suction cannula is more flexible and carries a lower risk of damaging the uterine lining. Manual vacuum aspiration, which uses a handheld syringe to create suction, has become especially widespread since the 1990s. It’s quieter than electric suction, can be done in an outpatient setting, and uses single-use equipment that reduces infection risk.
Anesthesia Options
A D&C can be performed under general anesthesia (where you’re fully asleep) or with deep sedation (where you’re heavily sedated but not on a breathing tube). The choice depends on the reason for the procedure, your overall health, and preferences you discuss with your care team. Interestingly, research has found that blood loss tends to be lower with sedation-based approaches compared to general anesthesia using inhaled agents. In one study, patients under general anesthesia lost an average of 290 mL of blood compared to about 88 mL for those who received IV sedation.
Recovery and What to Expect After
Most people return to normal activities within about five days. Some cramping and light bleeding in the days following the procedure is normal. You should use pads rather than tampons during this time, because your cervix needs time to close back to its normal size. While it’s still open, there’s a higher risk of bacteria entering the uterus and causing infection.
Your doctor will let you know when it’s safe to resume sexual activity, which is generally about one week after the procedure. Tampon use follows a similar timeline. Beyond that, there aren’t typically major restrictions on physical activity, and most people feel well enough to resume their daily routine within a few days.
Risks and Complications
D&C is considered a safe, low-risk procedure, but like any surgery, it carries some potential complications. The most serious is uterine perforation, where the instrument passes through the uterine wall. This is rare, occurring in roughly 0.8 to 6.4 out of every 1,000 procedures. The risk is lower in the first trimester (about 0.05%) and slightly higher in the second trimester (about 0.32%). Infection and excessive bleeding are also possible but uncommon.
The complication that gets the most attention is Asherman syndrome, a condition where scar tissue forms inside the uterus and can affect future fertility or menstruation. In a study of over 2,500 women who had curettage after an abortion, the incidence of Asherman syndrome was 1.6%. The biggest risk factor was having three or more prior procedures, which increased the risk by 4.6 times. This is one of the reasons the WHO recommends suction-based methods over sharp curettage when possible: the flexible plastic cannula is gentler on the uterine lining and less likely to cause the type of deep tissue damage that leads to scarring.
How Accurate Is a Diagnostic D&C?
When a D&C is performed to investigate potential cancer or precancerous changes, it’s a reasonably reliable tool, though not perfect. For detecting endometrial cancer, it correctly identifies about 77 out of 100 true cases. For atypical endometrial hyperplasia, a precancerous condition, the detection rate is about 80 out of 100. In both cases, the procedure is very good at confirming that someone does not have the condition, correctly ruling it out in 97 to 99 out of 100 people without disease. If a D&C result comes back negative but symptoms persist, your doctor may recommend further testing such as hysteroscopy, which allows direct visualization of the uterine cavity.