This is the traditional standard gynaecological investigation and treatment. Aims:
1. Diagnostic—to examine the endometrium (tissue lining the uterus) for abnormalities, including polyps, pre-cancer and cancer. Samples collected can be further examined under a microscope.
2. Therapeutic—to remove any abnormality, such as a polyp, abnormal endometrium, or retained remnants after a miscarriage or birth, or to retrieve certain (stringless) types of IUD.
Method. Either under general or local anaesthetic, the woman is placed in ‘lithotomy’ position, which means she is lying on her back, with her legs separated, and supported with the knees bent. A speculum is used to separate the walls of the vagina, and bring the cervix into view. The cervix is gently dilated with a series of thin probes, until about 8 or 9 millimetres in diameter. The doctor then uses a guide wire to assess the size and direction of the uterus. The cavity of the uterus is then checked with a pair of narrow forceps. Then a curette, which is like a little spoon with a hole in the middle, is passed through the cervix into the cavity of the uterus, and the walls of the uterus are gently scraped with the curette, so whatever is inside the uterus comes out. The whole business usually only takes about ten minutes. Variations on the technique include suction curettage. A woman may have a period-like bleed following a D and C.
Complications. It is a very safe procedure. It is commonly performed and the incidence of problems is small (said to be 0.5 to 1 per cent). But as with all procedures, there are potential risks.
Possible (rare) problems include heavy bleeding, damage to the cervix, uterus or, less commonly, the bowel, infection, adhesions within the uterus, and the risks associated with a general anaesthetic.
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