D and C

D and C is a procedure to scrape and collect the tissue (endometrium) from inside the uterus.

• Dilatation ("D") is a widening of the cervix to allow instruments into the uterus.
• Curettage ("C") is the scraping of the walls of the uterus.

Dilatation and curettage; Uterus scraping

D and C, also called uterine scraping, may be performed in the hospital or in a clinic while you are under general or local anesthesia.

The health care provider will insert an instrument called a speculum into the vagina. This holds open the vaginal canal. Numbing medicine may be applied to the opening to the uterus (cervix).

The cervical canal is widened using a metal rod, and a curette (a metal loop on the end of a long, thin handle) is passed through the opening into the uterus cavity. The doctor gently scrapes the inner layer of tissue, called the endometrium. The tissue is collected for examination.

This procedure may be done to:

• Diagnose conditions such as uterine cancer
• Remove tissue after a miscarriage
• Treat heavy menstrual bleeding or irregular periods (See: Bleeding between periods)
• Perform a therapeutic or elective abortion
• Investigate infertility

Your doctor may also recommend a D and C if you have:

• Endometrial polyps
• Thickening of the uterus
• An embedded intrauterine device (IUD)
• Bleeding after menopause
• Abnormal bleeding while on hormone replacement therapy

This list may not be all-inclusive.

Risks related to D and C include:

• Puncture of the uterus
• Tear of the cervix
• Scarring of the uterine lining

Risks due to anesthesia include:

• Reactions to medications
• Problems breathing

Risks of any surgery include:

• Bleeding
• Infection

D and C has relatively few risks, can provide relief from bleeding, and can help diagnose infection, cancer, infertility, and other diseases.

You may return to normal activities as soon as you feel better, possibly even the same day. There may be vaginal bleeding, as well as pelvic cramps and back pain for a few days after the procedure.

Pain can usually be managed well with medications. Tampon use is not recommended for a few weeks, and sexual intercourse is not recommended for a few days.

Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap. 37.

Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35(2):219-234.