Trigger warning: This feature mentions pregnancy loss, stillbirth, or both. Please read at your own discretion.
Dilation and curettage, or D and C, is a procedure that doctors use to remove tissues from the uterus. It has a number of uses, including diagnostic testing, miscarriage treatment, and pregnancy termination.
D and C is one of the most common gynecological procedures. It is very safe, and complications are rare. The overall mortality rate is about
During the procedure, a doctor slightly dilates the cervix, which is the bottom of the uterus. They then use a thin instrument to remove tissues. A D and C usually happens in an outpatient setting.
Read on to learn more about the D and C procedure, including its uses, what it involves, recovery, and the potential risks.
Doctors use D and C for several medical purposes, including:
Doctors can use a D and C to diagnose conditions such as endometrial cancer. To do this, they take a sample of the endometrium, which is the tissue that lines the uterus. They then analyze this tissue for signs that the cells might be abnormal.
During a diagnostic D and C, a doctor may also perform a hysteroscopy. This involves the use of a long, thin instrument with a camera on the end. It allows doctors to see inside the uterus.
A doctor may recommend these tests if someone has symptoms that could suggest a uterine condition, such as bleeding between periods.
A doctor may perform a D and C soon after they identify a miscarriage. Alternatively, they may perform one days or weeks afterward if there are signs that the body has but fully eliminated the pregnancy. In this scenario, a D and C may be necessary to save someone’s life and preserve their future fertility.
D and C is the most common procedure for terminating a pregnancy during the first trimester and the early second trimester.
- have a pregnancy that threatens their life, such as an ectopic pregnancy
- have a non-viable pregnancy, meaning the fetus has significant problems with development
- have a pregnancy that is a result of rape, incest, or coercion
- feel unprepared or unable to raise a child in a safe or stable environment
- not have the financial means to pay for the pregnancy or the cost of raising a child
- be very young
In a molar pregnancy, a group of cysts forms on the placenta, meaning it cannot nourish a developing fetus. A doctor must remove the pregnancy to prevent serious complications to the pregnant person.
Whether a D and C is painful depends on whether the person is awake during the procedure. Without sedation or anesthetic, it can be painful. Some feel little pain at all, while others feel considerable pain.
A 2020 study reports that most people who have a D and C experience moderate to severe pain. However, doctors can use sedation to make someone feel sleepy and less aware of the procedure. They may not remember much of it afterward.
Alternatively, doctors can use general anesthetic, which makes someone temporarily unconscious. Under general anesthesia, a person cannot feel anything at all.
People who are worried about pain may want to choose sedation or anesthesia. Others prefer to feel in control or may want to avoid any side effects from these drugs.
The procedure only takes a few minutes. So, even when there is pain, it does not last a long time.
Before undergoing a D and C, a person may need to take some steps to prepare. The preparation involved depends on whether someone is having anesthesia. If they are, they may need to fast beforehand.
During the procedure, a person will remove clothing from the waist down and then lie down on a table. They will place their feet in stirrups at the end of the table and use a sheet or blanket for privacy.
A doctor will then place a speculum in the vagina. This opens the vagina and allows them to see the cervix. They may inject a numbing agent into the cervix to reduce pain. The injection may cause a very brief pinching sensation.
Next, a doctor will use a dilator to slowly open the cervix. A person may feel cramping or tension in the stomach or back if they are awake.
The cervix usually only dilates to about a half inch (1.27 centimeters). This is much smaller than the 10 inches (25.4 cm) a person would experience during labor and childbirth.
After dilation, the doctor will use an instrument to remove tissues from the uterus. This usually takes very little time.
If someone has had sedation or anesthetic, they will need someone to drive them home afterward. For the rest of the day, a person will need to rest.
Depending on the circumstances, a D and C may involve a physical and emotional recovery process.
Physical recovery from a D and C does not take very long. A person may feel sleepy if they have undergone anesthesia. However, this should wear off in 1–2 days. They will be able to resume most of their usual activities as soon as they feel able.
There are a few exceptions to this, though. For 1 week after the procedure, a person must not:
- go swimming, bathe, or visit spas
- use tampons, or other objects someone inserts into the vagina
- have sexual intercourse
During this time, a person can take showers to wash themselves.
It is typical to experience some symptoms after a D and C. This may include mild pain, cramping, and bleeding that resembles a light period. The symptoms may last between 10–14 days.
To relieve them, a person can use heat packs, over-the-counter (OTC) acetaminophen, and period products such as sanitary pads to manage the bleeding.
It is important to have a checkup with a doctor 14 days after a D and C. If the bleeding and pain are still occurring by this point, a person should speak with their doctor about it.
Emotional recovery from a D and C varies from person to person. Sometimes, it is a routine procedure that does not have any lasting impact.
For example, a 2020 study found that 5 years following an abortion, 99% of people who had an abortion still felt it was the right decision. At all stages following the procedure, the most common emotional response was relief.
How someone feels depends on the factors surrounding their decision. The researchers found that difficulty making the decision to terminate, as well as stigma from others, predicted which participants had negative feelings about their abortion.
Whether a person wanted the pregnancy is also a big factor. For example, someone undergoing a D and C due to the loss of a wanted pregnancy may feel intense grief.
There is no right or wrong way to feel after a D and C. If someone feels it may be a difficult experience for them, it may help to:
- take a few days off work
- arrange some comforting, low-energy activities for afterwards, such as watching films
- spend time with others, such as a partner or close friend
If someone is experiencing long lasting distress and are finding it hard to cope, they can consider speaking with a therapist.
The overall risk of complications for D and C procedures is very low. If they do occur, they may include:
- excessive bleeding
- perforation in the uterus, although this is rare
It is a myth that abortions cause mental health problems or “post-abortion syndrome.” In fact, people who want an abortion but cannot access one tend to have higher levels of anxiety and lower self-esteem than those who can.
The Turnaway Study compared people who have abortions to those who cannot have one due to legal restrictions. It found that there is no difference between rates of depression in those who have abortions versus those who do not.
Contact a doctor as soon as possible if any of the following occur after a D and C:
- fever or chills
- severe pain that does not get better with OTC pain medication
- bad-smelling vaginal discharge
- heavy bleeding that requires someone to change their pad every 10–20 minutes
- passing of pregnancy tissue
- passing of blood clots that are larger than a 50 cent coin
Without treatment, an infection can spread and become serious, so it is important to seek advice right away if any signs develop.
Dilation and curettage (D and C) is one of the most common gynecologic procedures.
A D and C can be a diagnostic or therapeutic procedure. It may hurt, but the procedure is short. A person may choose to receive sedation or general anesthetic to reduce the pain.
After a D and C, it is important to take time to rest and recover. Some may benefit from speaking with others who have been through the same experience or from contacting a therapist or hotline support service, such as Exhale Pro-Voice.