A dilation and curettage (D&C) is a short surgical procedure in which the cervix is gradually opened and tissue is removed from the inside of the uterus. The entire process typically takes 15 to 30 minutes and is performed in a hospital, surgical center, or clinic. It’s done for several reasons: to diagnose unexplained bleeding, to treat a miscarriage or incomplete pregnancy loss, or to remove tissue after delivery. Here’s what actually happens during the procedure and what to expect before and after.
Why a D&C Is Done
The most common reasons fall into two categories: diagnostic and therapeutic. A diagnostic D&C collects a sample of uterine lining so it can be examined under a microscope. This helps identify causes of abnormal uterine bleeding, investigate abnormal cells found during other tests, or check the lining in people experiencing postmenopausal bleeding.
A therapeutic D&C removes tissue from the uterus rather than just sampling it. This is often performed after a miscarriage to clear retained tissue that hasn’t passed on its own, after an incomplete miscarriage where some tissue remains, or following childbirth if pieces of the placenta are still attached to the uterine wall. It can also be used to remove uterine polyps.
Anesthesia Options
Before the procedure, your provider will recommend an anesthesia approach based on your medical history and the reason for the D&C. The main options are general anesthesia, where you’re fully asleep, and regional anesthesia (like an epidural), which numbs you from the waist down while you stay awake. Local anesthesia, which numbs only the cervix, is sometimes used for shorter diagnostic procedures. If general anesthesia is planned, you’ll typically need to fast for several hours beforehand.
The Procedure, Step by Step
You lie on your back on an exam table with your heels resting in stirrups, the same position used for a pelvic exam. Your provider inserts a speculum into the vagina to hold the vaginal walls apart and bring the cervix into view.
Next comes the dilation phase. A series of thin rods, each slightly thicker than the last, are inserted into the cervical opening one at a time. Each rod gently stretches the cervix a bit more until it’s wide enough for instruments to pass through. In some cases, your provider may use a medication or a small device placed in the cervix hours before surgery to soften and begin opening it ahead of time, which can make this step quicker and more comfortable.
Once the cervix is sufficiently dilated, the rods are removed and the actual curettage begins. Your provider passes a long, thin instrument called a curette through the cervix and into the uterus. With this tool, the tissue lining the inside of the uterus is carefully removed. There are two main techniques for this step: sharp curettage, which uses a spoon-shaped curette with a sharp edge to scrape the lining, and suction curettage (vacuum aspiration), which uses gentle suction to draw tissue out.
Sharp Curettage vs. Suction Curettage
These two approaches accomplish the same goal, but they are not equally recommended. Both the World Health Organization and the International Federation of Gynecology and Obstetrics recommend vacuum aspiration over sharp curettage for uterine evacuation. The evidence behind that recommendation is substantial.
Multiple systematic reviews have found that vacuum aspiration is equally effective as sharp curettage for treating early incomplete and missed miscarriages, while reducing procedure time, blood loss, and pain. In a large retrospective study of more than 80,000 women seeking induced abortion, vacuum aspiration was associated with less than half the rate of both major and minor complications compared to sharp curettage. A second series of over 100,000 procedures found that sharp curettage, whether performed alone or combined with vacuum aspiration, was significantly more likely to result in complications, particularly incomplete evacuation.
One specific concern with sharp curettage is a condition called Asherman’s syndrome, in which scar tissue forms inside the uterus and can cause the walls to stick together. This can affect future menstrual cycles and fertility. In one study tracking 884 women who underwent different management approaches for early pregnancy loss, 1.2% of those treated with sharp curettage developed Asherman’s syndrome, while zero cases occurred among those managed with vacuum aspiration or medication. The risk is low overall, but it’s essentially absent with the suction technique. If you’re having a D&C and have concerns about which method will be used, it’s worth asking your provider.
What the Procedure Feels Like
Under general anesthesia, you won’t feel or remember any part of the procedure. Under regional anesthesia, you may feel some pressure or tugging in your lower abdomen but no sharp pain. With local anesthesia alone, cramping during dilation and curettage is common, ranging from mild to moderately uncomfortable. Many providers offer sedation alongside local anesthesia to help you relax.
The procedure itself is quick. Once the cervix is dilated, the tissue removal portion often takes only a few minutes. Including preparation and dilation, the total time in the procedure room is usually under 30 minutes.
Recovery in the First Few Days
After the procedure, you’ll spend time in a recovery area while anesthesia wears off. If you had general anesthesia, expect to feel groggy for a few hours. Most people go home the same day.
Cramping similar to menstrual cramps is normal for the first day or two, and mild spotting or light bleeding can continue for up to two weeks. Over-the-counter pain relievers are usually enough to manage discomfort. Most people return to normal daily activities within a day or two, though your provider may recommend avoiding tampons, sexual intercourse, and baths (showers are fine) for about two weeks to reduce infection risk. Your next menstrual period may arrive earlier or later than expected, as the uterine lining needs time to rebuild.
Risks and Warning Signs
Serious complications from a D&C are uncommon. The main risks include infection, heavy bleeding, and perforation of the uterine wall (when an instrument accidentally pokes through). Perforation sounds alarming but typically heals on its own without further treatment.
As discussed above, Asherman’s syndrome is an infrequent but important long-term risk, especially with sharp curettage or repeat procedures. In the study mentioned earlier, half of the women who developed Asherman’s syndrome had undergone more than one curettage, suggesting that repeat procedures increase the likelihood of scar tissue formation.
After going home, watch for signs that something isn’t healing normally: fever, heavy bleeding that soaks through a pad in an hour or less, worsening pelvic pain rather than improving pain, or foul-smelling vaginal discharge. Any of these warrant a prompt call to your provider.