An Endocervical Curettage (ECC) is a specialized diagnostic procedure used in gynecology to evaluate the health of the inner cervical lining. A healthcare provider may recommend an ECC when routine external screenings, such as a Pap test, suggest a potential issue requiring a more precise internal examination. This procedure provides a direct tissue sample from an area often inaccessible to standard screening tools, serving as a step in the early detection of cellular changes within the cervical canal.
Defining Endocervical Curettage
The term endocervical curettage defines its function and location. “Endocervical” refers to the endocervix, the canal connecting the vagina to the uterus. “Curettage” describes the gentle scraping or sampling of the tissue lining this canal. The procedure’s purpose is diagnostic, aiming to obtain a microscopic sample of the cells that line the endocervical canal.
The targeted area for sampling is often the transformation zone, a biologically dynamic region of the cervix where most precancerous changes originate. Unlike a Pap smear, which collects superficial cells, the ECC uses a small instrument called a curette or a specialized brush to reach deeper into the canal. This allows for the collection of a substantial tissue specimen from the mucosal membrane of the endocervix. The collected sample is then sent to a pathology laboratory for microscopic analysis to identify abnormal cellular structures.
Clinical Reasons for Recommending an ECC
A healthcare provider recommends an ECC when less invasive screenings, like a Pap or HPV test, suggest abnormalities originating higher up in the cervical canal. A frequent indication is an abnormal Pap test result classified as Atypical Glandular Cells (AGC), which points toward potential issues with the glandular tissue lining the endocervix. The ECC is a necessary follow-up to precisely locate and characterize these glandular cell changes.
The procedure is also standard during a colposcopy when the squamocolumnar junction (SCJ) cannot be fully visualized. This situation, often called a non-satisfactory colposcopy, means the area of highest risk for cellular transformation is hidden from external view, often due to a patient’s anatomy or menopausal changes. Furthermore, an ECC may be performed to investigate unexplained abnormal uterine bleeding, especially in post-menopausal patients, to rule out precancerous or cancerous conditions of the inner cervix or uterine lining.
What to Expect During the Procedure
The Endocervical Curettage is typically performed in an outpatient setting and usually takes only a few minutes. Patients are positioned on the exam table similar to a standard pelvic exam to allow the provider access to the cervix. Preparation involves avoiding sexual intercourse, douching, tampons, and vaginal medications for at least 24 hours prior to the appointment.
Before sampling begins, a speculum is inserted to visualize the cervix. The provider may stabilize the cervix using a slender instrument called a tenaculum, which may cause a brief pinch. A cleaning solution, such as dilute acetic acid (vinegar) or iodine, is often applied to help highlight any potentially abnormal areas.
The provider carefully inserts the narrow curette (a small, spoon-shaped instrument) or a specialized brush into the endocervical canal. The curette is gently rotated and scraped along the inner lining to collect the tissue sample. Patients commonly report feeling a brief, sharp cramping sensation, similar to a severe menstrual cramp, during this part of the procedure. This discomfort is temporary, and providers often recommend taking an over-the-counter pain reliever, such as ibuprofen, about 30 minutes beforehand to minimize cramping.
Recovery and Interpreting Results
Following the ECC, most patients can return to their normal daily activities almost immediately, though some restrictions are advised. Light vaginal bleeding or spotting is common for one to two days. Mild cramping may persist for several hours, which usually responds well to over-the-counter pain relief. Patients should abstain from inserting anything into the vagina (including tampons, douches, and sexual intercourse) for 48 hours up to one week to allow the cervix to heal and reduce infection risk.
The tissue sample is preserved and sent to a pathology laboratory for examination under a microscope. Results are typically available within one to two weeks, and the provider will schedule a follow-up appointment to discuss the findings. The pathology report classifies the cells as normal, benign, or abnormal, such as precancerous lesions like Cervical Intraepithelial Neoplasia (CIN). If abnormal cells are identified, the next steps may involve increased monitoring or a further therapeutic procedure, which the healthcare provider will discuss to create an appropriate management plan.