The term “banjo curettage” may appear in older medical texts or in conversations with healthcare providers, but it refers to a common gynecological procedure known today as Dilation and Curettage, or D&C. This procedure involves two distinct steps: gently widening the opening of the uterus, followed by the careful removal of tissue from the uterine lining. The D&C is a brief surgical intervention used for both diagnostic purposes, such as investigating abnormal bleeding, and therapeutic reasons, like clearing the uterus after a miscarriage. Understanding this procedure, its purpose, and its steps can help demystify this frequently performed surgical procedure in women’s health.
What Banjo Curettage Refers To
The colloquial phrase “banjo curettage” is derived from the shape of a specific surgical instrument used in the procedure. This instrument, called a curette, is a long rod with a loop or spoon-like tip used for scraping tissue. In some designs, the instrument’s handle or overall shape resembled a banjo, giving rise to the outdated nickname.
The modern and precise medical term is Dilation and Curettage (D&C), which accurately describes the two main actions performed. Dilation refers to widening the cervix, the narrow, lower part of the uterus. Curettage is the subsequent step where the healthcare provider uses the curette or a suction device to remove tissue from the endometrium, the lining of the uterus. This procedure is a fundamental method for accessing and sampling the interior of the uterus.
Why This Procedure is Performed
The D&C procedure serves a dual purpose in gynecologic care: as a diagnostic tool and a treatment method for various conditions affecting the uterus.
Diagnostic Uses
For diagnostic purposes, the procedure allows a healthcare provider to obtain a tissue sample from the endometrium. This is often done to determine the cause of unexplained or excessive uterine bleeding, especially in postmenopausal women or those bleeding between periods. The collected tissue is sent to a laboratory for microscopic analysis. Pathologists check for abnormal cells, polyps, fibroids, or signs of uterine cancer. Detecting these conditions early through a biopsy is a primary diagnostic application of the D&C.
Therapeutic Uses
From a therapeutic standpoint, the D&C is effective for managing conditions requiring tissue removal from the uterus. A common use is clearing the uterine cavity after a miscarriage, sometimes called uterine evacuation. By removing any remaining pregnancy tissue, the D&C helps prevent infection and heavy, prolonged bleeding. The procedure is also used to treat heavy or prolonged menstrual bleeding that has not responded to medication by removing the thickened endometrial lining. Additionally, it may be necessary to remove tissue remaining after childbirth, such as small fragments of the placenta.
How the Procedure is Done
A D&C is typically performed in a hospital operating room or an outpatient surgical center, usually lasting only 5 to 15 minutes. The patient is positioned on an examination table with their feet in stirrups, similar to a standard pelvic exam. Anesthesia is administered to ensure comfort, ranging from local numbing of the cervix to regional or general anesthesia, depending on the patient’s health and the complexity of the case.
Once the patient is comfortable, a speculum is inserted into the vagina to hold the walls apart and allow the healthcare provider to visualize the cervix. The first step, dilation, involves gently widening the cervical opening. This is achieved by inserting a series of thin metal rods, called dilators, each slightly thicker than the last, to gradually stretch the cervical canal. Alternatively, medication may be given hours before the procedure to help soften and open the cervix.
Following sufficient dilation, the curettage phase begins. The healthcare provider inserts the curette, which may be a sharp, spoon-shaped instrument, or a slender tube connected to a suction device, known as suction curettage. This instrument is carefully guided into the uterus to scrape or suction the tissue from the endometrial lining. The entire process is guided by the provider using gentle, precise movements to complete the tissue removal.
What to Expect During Recovery
Immediately following the procedure, the patient is moved to a recovery room where nurses monitor vital signs until the effects of the anesthesia wear off. If general anesthesia was used, feeling groggy or slightly nauseous for a few hours is normal. Because of the anesthesia, patients must arrange for a ride home and should not drive or operate machinery for at least 24 hours.
Mild cramping is common and is comparable to menstrual cramps, usually subsiding within a day or two, and can be managed with over-the-counter pain relievers. Light vaginal bleeding or spotting may also occur for several days to a couple of weeks. Sanitary pads should be used instead of tampons to reduce the risk of infection. Most patients can return to their normal daily activities, including work, within one or two days.
Patients are typically advised to avoid placing anything into the vagina, including tampons or having sexual intercourse, for a period recommended by the healthcare provider, usually one to two weeks, to allow the cervix to close and heal. It is important to contact a doctor immediately if severe pain, heavy bleeding that soaks more than two pads an hour, fever, or foul-smelling vaginal discharge develops, as these can be signs of a complication or infection. The next menstrual period may arrive earlier or later than usual as the uterine lining rebuilds itself.