FAQ - Curetting

What is Curetting?

To scrape carefully, the inner most lining (endometrium) of uterus is curetting.

A spoon-like instrument called ‘curette’ is used for this process, and so the word ‘curetting’.

According to people curetting is to remove unwanted pregnancy or to complete the incomplete abortion. In layman’s terms, curetting is “ to wash (clean) the uterus” but this is not a good word. Actually there is no process like washing. Monthly menses is a normal process in woman’s life and there is nothing unhygienic about it, as uneducated people think. The wrong meaning of the word curetting must have evolved form this misconcept.

Curetting is a minor operation in Obstetrics and Gynecology. If it is done carefully for the right purpose or indication, then it is beneficial in many ways. At the same time, if it is done carelessly or unnecessarily, then it may prove harmful.

Why is curetting done ? Curetting is done for diagnosing and treating some diseases of female genital tract.

For Diagnosis :

This operation is done for diagnosing the following diseases of female genital system:

1)    Complaints about menses (irregularity, heavy flow, early stoppage of menses, delayed periods). Curetting is done to diagnose the cause of irregularity of menses. If the scraped endometrium is viewed under microscope, then it is possible to comment on the effect of the hormones produced by ovaries on the endometrium.

2)    While investigating for infertility, if sperms of the husband are normal, then we have to look for the maturity of the egg formed in ovary (ovulation). Until now, that was assessed by curetting only. But now-adays we can know the maturity of the egg (graafian follicle) by measuring the levels of the hormone ‘Progesterone’ in the blood and also by sonography. Still curetting is done if above two tests are not available.

3)    Just before menopause, some females complain of heavy flow. Whether that is because of hormonal imbalance or a warning of early cancer is exactly differentiated by curetting. Tuberculosis and cancer of uterus are diagnosed by curetting.

 

For Treatment:

Curetting is done as treatment of some diseases of uterus :

1)    Curetting is done for diagnosing the cause of heavy flow. In about 30-40% of females this disease is cured. Though the scientific reason behind its cure is not known, curetting is done as it has proved to be beneficial.

2)    While inserting the curette the mouth of the uterus needs to be temporarily dilated. In medical terms curetting is called Dilatation and Curettage i.e. : D & C. In certain situations only the cervix needs to be dilated, e.g. when uterus is filled with pus or when radium rods need to be kept in uterus as a treatment of cancer.

3)    It is also done to complete the incomplete abortion, by removing remaining products of conception from uterus.

 

We have seen when and why curetting is really needed. So, curetting done for ‘white discharge’ or for pain in abdomen’ is totally wrong. Only when it is done for the proper indication it proves beneficial to the patient.

How is curetting done ?

This operation can be done by anesthetizing (local anesthesia) only the cervix (mouth of uterus). But patient receives some pain in this procedure and full cooperation to the operating doctor, without any movement is not possible. For totally painless operation, General anaesthesia is needed.

After giving Local or General Anaesthesia, a rod called dilator is inserted through the cervix for dilatation. Then curette is inserted to scrape the endometrium. If it is done for diagnostic purpose, the scraped material is sent to the pathologist. The whole operation requires only 5-10 minutes.

This operation needs to be done 1-2 days before the menses in cases of menstrual irregularity, early stoppage of menses, infertility. It is done to know the effect of hormones produced by ovary on the endometrium. If done after 24 hours of commencement of menses, it is not useful as the endometrium is already shed off. It is important to carry out curetting as above-mentioned period for menstrual irregularity and infertility.

Is there any complication of the operation?

Because of the progress in anesthesiology and medical sciences, dangers in this operation are markedly reduced. Still this operation has to be done by skilled doctor and with great care. If instructions given under precautions to be followed before and after operation are followed then complication rate will be still decreased.

Complications occurring during and after the operation :

1)    Uterus may get infected and fallopian tubes which carry eggs may get blocked resulting in infertility.

2)    In rare situation when endometrium is scrapped more 8 than required or when curetting is done frequently, endometrium is fully destroyed resulting in Ashermann’s Syndrome. Here menses totally stop or they are scanty. This leads to infertility.

3)    While dilating cervix, it may get injured. If done frequently cervix may become loose and subsequent pregnancy may end up in abortion or preterm labour.

4)    Repeated to and fro movements of curette during this operation may perforate the uterus and injure structures surrounding it. In that case abdomen needs to be opened to take care of the injuries.

 

If the operation is done carefully, the rate of above mentioned complications is decreased markedly but still life threatening complication can occur in a very rare situation.

 

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