Therapeutic Curettage

Curettage is a medical procedure that is known to most of us mainly as a method for performing an abortion, but today it also serves for other purposes and is called therapeutic curettage. Therapeutic curettage enables the removal of superfluous tissue from the uterus and its environs – tissue that remained for various reasons and that could cause infection or bleeding.

What is therapeutic curettage?

Curettage is a long-established method, that has been in use for many years in the world of gynecology. It is quite a short procedure, done by two methods: vacuum aspiration or physical removal of the contents of the uterus using special means – the procedure that gave curettage its name.

Many people associate curettage with induced abortion, as it is considered to be a common method for induced abortions, primarily until Week 21 or Week 22 of pregnancy. When the curettage is performed during the first trimester of pregnancy, it will usually be performed by means of vacuum suction, while in more advanced stages, actual curettage will be performed.

Curettage, then, is very common for induced abortions, but it is not performed for this reason only: in certain cases, tissue remains in the uterus – superfluous tissue which, if it remains there, could cause the development of infection in the uterus or massive bleeding from it – and it, therefore, needs to be removed. In these instances also, curettage will not infrequently be selected as the appropriate treatment, in which case it will be called therapeutic curettage.

How is therapeutic curettage performed?

As a rule, therapeutic curettage is performed in the way that it is performed for the purpose of induced abortion, but it may be quicker and less painful (if it is relatively easy to access the tissue and if the amount of tissue removed is not particularly large). All events, it is a procedure that usually takes a few minutes.

In order to perform the curettage, you will be anesthetized, usually with general anesthesia, although on occasion it is also done under regional anesthesia only – in accordance with various considerations that the medical team will share with you.

Before it is commenced, the cervix will be dilated using special medications, in order to make the procedure easier and quicker, both for you and for the physician. After dilation of the cervix, the curette will be introduced into the uterus, and the tissue remnants will be removed from it. On completion of the procedure, the physician will verify that no residual tissue remains in the uterus, in order to avoid a repeat therapeutic curettage.

When is therapeutic curettage required?

Therapeutic Curettage will typically be performed in two cases:

• After a natural miscarriage: During a miscarriage, the uterus usually empties out completely, but on occasion, some tissue remains in the uterus. Since its presence in the uterus could, as mentioned above, cause infection or bleeding, curettage should be performed, which will completely empty the uterus.
• After an operation to remove a myoma: A myoma is a type of benign tumor that develops from the uterine muscle tissue and is considered to be quite common. Myoma will not always cause symptoms, but when symptoms appear they need to be treated, usually by removing it. In a small percentage of cases, superfluous tissue could form in the uterus after the procedure, and by means of curettage, it is completely removed.

Common symptoms

Effects such as acute bleeding or prolonged pain after a miscarriage or an operation to remove a myoma constitute a good indication of the presence of residual tissue in the uterus, which can be assumed to almost always necessitate therapeutic curettage, upon which the treating physician will decide.

Incidentally, when therapeutic curettage is considered after a miscarriage, a certain waiting period may first be decided upon, as on occasion the uterus empties out naturally after a certain period. Statistics show that about 50% of women who wait for natural emptying of the uterus avoid having curettage performed, but if the uterus does not empty out after a few weeks, the therapeutic curettage will be performed as planned.

Recovery from therapeutic curettage

The curettage is usually done in a day-hospitalization setting, and you will therefore usually be discharged from hospital on the same day, a few hours after the medical procedure is completed. In the next few days, you may experience pain in the region of the lower abdomen, as well as in the region of the vagina, but this could pass within a number of days. Significant bleeding is also characteristic in the days following therapeutic curettage, and could even continue for two weeks.

In the first week after the curettage, it is not recommended to have sexual intercourse (which could also be painful at this stage, naturally), and as a rule – it is preferable to resume sexual relations only after the bleeding stops. The first menstrual period will generally appear one to one-and-a-half months after the curettage is performed.