Curettage: what is it and when to do uterine scraping?

Curettage is a gynecological procedure that can cause distress in many women. Because it is invasive, fear of feeling pain and recovery are some of the factors that cause most fear.

The procedure is often necessary in delicate situations, such as in cases of incomplete spontaneous abortion or retained abortion, which makes the situation even more uncomfortable for the woman.

Despite this, there are cases in which curettage is the only effective method of treatment and diagnosis, helping women to prevent major health complications.

In the text below, we clarify how it is performed, the type of anesthesia and the care needed in recovery.

What is uterine curettage?

Curettage is a medical procedure done to clean a woman’s uterus. It is divided into two types, endocervical curettage (access only to the endocervical canal – cervix) and uterine curettage .

In the endocervical type, the procedure aims at the diagnosis of diseases. It is used to collect endocervical uterine tissue (cervical canal) for laboratory analysis and to rule out diseases such as polyps and cervical canal injuries.

Uterine curettage, on the other hand, is a procedure used when an incomplete or retained spontaneous abortion occurred, after natural delivery (for removal of retained placenta) or also for indication of uterine curettage to rule out endometrial diseases, such as polyps, endometrial hyperplasia and endometrial carcinoma. .

Although it is not a complicated procedure, it is an invasive method of treatment and diagnosis. It is made with a device called a curette, which is similar to a spoon.

The doctor in charge is the gynecologist. It scrapes the tissues and wastes from the uterus through the vaginal canal.

Therefore, having a dilated vagina is important to facilitate the procedure.

If there is no natural dilation, the doctor can induce it through the use of medical instruments or medications.

This dilation is important for the doctor to be able to access the uterus through the vaginal canal more easily.

In order for the woman not to feel pain, curettage should always be done under anesthesia, which can be general, spinal anesthesia or epidural.

The duration of this procedure can vary, taking an average of 15 to 30 minutes. In more complicated cases, it may take longer.

In the field of dermatology, curettage also serves the same purpose as treatment by scraping. However, it applies in cases of cancerous lesions on the skin.

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How is curettage performed?

Gynecological curettage is a medical procedure performed by specialists in the field of gynecology and obstetrics. It consists of a scraping done on the inside of the uterus with a surgical instrument similar to a spoon, called a curette.

Anesthesia is required and must be performed in a hospital. Although this scraping is done carefully, it must be done with anesthesia so that the patient does not feel pain.

When the curettage is made for diagnosis, the material is collected and sent for analysis (biopsy).

For this cleaning, the doctor accesses the uterine cavity through the vaginal canal, which needs to be dilated.

This dilation, when it does not happen spontaneously, needs to be induced. For this, it is possible to choose the use of surgical instruments or medications, the latter less invasive option.

When is it necessary to do?

The main recommendation for curettage is for uterine emptying in cases of retained or incomplete abortions, or for cleaning the uterus after delivery. However, even in these cases it can be replaced by procedures such as vacuum uterine emptying.

Because it is more invasive, curettage is not the first recommendation when the objective is to make a diagnosis, but in some cases it may be necessary to rule out possible pathologies.

The first curettage recommendations, therefore, include the following situations:

  • Scraping of ovular remains when there is an abortion, especially when the remains are present for more than 4 weeks inside the uterus;
  • Removal of placental remains in normal delivery, when retained placental remains are suspected.
  • Removal of benign tumors (uterine polyps);
  • Egg removal without embryo (anembryonic pregnancies);
  • Diagnosis of endometrial cancer;
  • Investigation of endometrial hypertrophy.

Read more: Urinary tract infection can lead to abortion

What is the risk of not doing curettage?

In some specific cases, there is a greater risk of not doing the curettage. It is not the case of curettage for diagnosis, but in the procedure as a treatment.

After an abortion, for example, it is necessary for the woman’s uterus to be clean to avoid complications, such as septic abortion, a type of infection that can cause problems such as fever (even with delusions), accelerated heart rate in women, risk of loss of the uterus and even septic shock and death.

This type of complication is not very common in spontaneous abortion, being more frequent in cases of induced abortion. However, it is a possible risk and therefore it is necessary that treatments are done for this cleaning of the uterus.

This is the same case when curettage is performed to remove the retained placenta.

How long to rest after curettage?

After performing the procedure, it is necessary for the woman to remain in the hospital for a few hours under observation, but it can be released about 6 hours after the curettage is performed.

At home, rest should continue. It is important that the diet on the day of the procedure is light and that activities that require great physical effort are not carried out.

The time needed for a woman to rest at home can vary from 1 to 3 days, when there are no complications. Thus, she will be able to resume her activities soon.

Some women may need a longer rest period, which will be evaluated by the doctor who performed the procedure.

How many days after curettage can you have sex?

On average, a woman should avoid sexual intercourse for two weeks after the procedure. This time allows the uterus to be fully recovered, avoiding risks and complications, such as pain in the region or possible infections. This time can change according to the reason that made the woman do a curettage.

How soon does the uterus fully recover?

It depends . The time for the uterus to be fully recovered may vary according to the cause of the curettage. In cases of abortions in more advanced pregnancies, the recovery time can be similar to what takes in childbirth, with an average of 40 days.

In these cases, there is a longer time for uterine involution to normal volume, closure of the cervix and pre-pregnancy conditions are resumed. In earlier pregnancies, the time may be shorter, around 2 weeks, until the bleeding stops and the cervix becomes impervious (inaccessible).

In diagnostic curettage, the recovery time can be quick, as it is a milder procedure, since the collection of uterine tissue causes less damage when compared to curettage for cleaning the uterus.

What type of anesthesia is used for curettage?

Anesthesia to perform the curettage is mandatory so that the woman does not feel pain, but the type applied for the procedure can vary according to each patient, as the doctor must consider her emotional and physical state. Therefore, general, epidural or spinal anesthesia can be used.

In general anesthesia, the woman is not conscious during the procedure and must wake up only when the curettage is finished.

The epidural and spinal are regional anesthesia, and may be associated with sedation. The spinal cord is applied with the use of a needle inserted in the region of the back, in the spinal column.

The anesthetic is applied inside the spinal fluid, causing muscle relaxation and temporary numbness. This type is widely used in cesarean deliveries.

In the case of epidural anesthesia, more common in normal births, the anesthetic is injected through a catheter placed in the epidural region (around the spinal canal).

Thus, during the procedure, it is possible to constantly administer the anesthetic in the woman’s body, while in spinal anesthesia it is only one application.

How long can you bleed after curettage?

A small persistent bleeding for a few days after curettage is considered normal. Depending on the reason for the procedure, this symptom can last for three days or even two weeks.

Even though it is a light bleed and without other symptoms, it is important that the woman keeps the doctor who performed the curettage informed.

This bleeding is expected to decrease over the days, until it stops completely.

If it is intense, has a very strong or altered smell, is coagulated and the patient has other symptoms (colic and fever, for example), it is essential to seek a gynecologist to investigate the cause.

In such cases, he may order other local tests to understand the cause of the bleeding and start appropriate treatment.

Necessary care after curettage

Usually, the recovery of a curettage is considered simple, requiring only rest and some small care from the woman, so that it is possible to prevent complications and discomfort in the intimate region.

In general, in the first few days it is not recommended that the woman make physical efforts, avoiding going to work, practicing physical exercises or housework.

Therefore, the ideal is for the woman to use this time to relax, lying down and resting as much as possible.

In post-abortion curettage of a more advanced pregnancy, for example, the resting time can be much longer, compared to the necessary care after delivery.

Other precautions include:

  • Avoid sexual intercourse for two weeks, especially in curettage in early pregnancy;
  • In late abortions or with the presence of infection, the woman may need a longer hospital stay and use of antibiotic medications;
  • Avoid immersion baths until the next menstrual cycle is completed, opting only for showering;
  • Do not use an intimate shower for vaginal hygiene;
  • Do not use intimate tampons in the first month after performing curettage.

Just as care is needed for the woman’s physical well-being, in curettage after an abortion, psychological counseling can also be advised, so that the woman can mentally recover from the loss.

Does curettage hurt?

The procedure itself does not hurt, as it must be done under anesthesia. During recovery, it is possible for a woman to experience cramps similar to those that can occur during menstruation. These cramps are a type of cramp that occurs due to the intense contraction of the uterus during the procedure.

However, the pain should not be constant or become severe during recovery. If so, the patient should see a doctor.

To improve this discomfort, the doctor may suggest using painkillers and a hot water bottle.

How is the first menstruation after curettage?

Menstruation after a curettage can have some variations, such as a delay in the cycle. In addition, the woman may experience more painful cramps than usual.

The presence of clots in menstrual blood can also occur, but it does not mean a new abortion or remnants of abortion still present in the uterus.

These clots are tissues that line the uterus that may have remained from the previous month.

Is curettage a dangerous procedure?

Despite being a relatively simple procedure and with complications considered rare, the chances of risks exist. The main ones are injuries, uterine perforation, infections and hemorrhage.

Some of these complications are related to the professional’s techniques and not to the procedure directly, so with a trained medical team the risks are very low.

Therefore, the woman must stay for a few hours in the hospital under observation. If there is a sign of pain or heavy bleeding, it is possible to have access to treatment urgently.

What are the symptoms after curettage?

After curettage, some symptoms are considered common, such as minor bleeding and mild cramps. Other signs may indicate a more serious complication and indicate that medical help is needed, such as:

  • Intense bleeding, which requires changing the absorbent at all times;
  • Strong pains that do not improve even with the administration of analgesic drugs and the use of a thermal bag;
  • Fever;
  • Vaginal discharge with bad odor.

Delay in the menstrual cycle is not considered a worrying symptom, as the uterus takes time to recover from curettage and this affects the menstrual cycle, causing a delay in certain cases.

Does curettage affect fertility?

Uneventful curettage is not a procedure that affects a woman’s fertility, even in cases of abortion. However, to try a new pregnancy it is necessary that the woman wait a time that can vary from 3 to 6 months.

If the abortion occurred is from an initial pregnancy, it is recommended that the woman wait at least 3 months to start planning a new pregnancy.

In pregnancies that were more advanced, the minimum waiting time is 6 months. This interval is necessary even so that the pregnancy is not at risk, as the uterus needs to be recovered.

Thus, it is possible to have some menstrual cycles and allow time for the endometrium to not be so thin, which increases the risk of a miscarriage.

It is also a necessary time to rule out synechiae, which are adhesions inside the uterus that may appear after the procedure and that would make it difficult to start a new pregnancy.

How much does a curettage cost? Are you in SUS?

The value of a curettage in private health services varies greatly according to the plan and the region of the country in which the person resides. However, for those who need to perform the procedure and do not have access to a private clinic, they can do it through SUS, free of charge.

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