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D-and-C is an abbreviation for one of the most common operations performed on women of all ages. The initials stand for dilatation and curettage, and refer to a short surgical operation usually done under general anesthesia, although it can be done under local anesthesia too. During this operation, the mouth of your womb, or cervix, is opened up or dilated to about the size of your thumb, and the lining of your womb is then scooped out with a spoon-like instrument called the curette. The D-and-C is usually used as a diagnostic tool. But it can also be used as a treatment.

A newer procedure known as HYSTEROSCOPY may eventually replace many of the uses of the D-and-C. Hysteroscopy refers to an operation in which a small lighted instrument (scope) is used to look inside your uterus (hystero). The hysteroscope is inserted through your vagina and cervix into your womb. A side connection to the scope allows a salt or sugar solution or carbon dioxide gas to flow into the uterus, expanding it and making it easier to see inside.

The advantage over the D-and-C is that the doctor can see the entire lining of the uterus. Since the cervix doesn't have to be opened up in hysteroscopy for diagnostic purposes, it can be done in the office, using no anesthetic or a local anesthetic. The hysteroscope can also be used for treating many conditions. For simple operations, little or no anesthesia is required. For longer and more complex operations, a general anesthetic is definitely required.

"Perhaps the most exciting advance in the field," says Dr. Patrick Taylor, a professor at the University of British Columbia who trains physicians in the use of the hysteroscope and who has co-authored a book on the subject, "is the ability to perform both minor and more complex operative procedures by hysteroscopic means." The use of a video camera attached to the hysteroscope allows the doctor to be guided by watching the picture of the inside of the uterus on a television screen during surgery, thus allowing even greater accuracy.

Currently, there is a shortage of physicians trained in this procedure in both Canada and the U.S. Many centers in both countries lack the necessary equipment.

Dr. Taylor adds that "No [doctor] should embark on a new surgical approach until they are trained and comfortable with both the technique and the management of any complications that may arise."

For Diagnosis

ABNORMAL VAGINAL BLEEDING: Both hysteroscopy and D-and-C are commonly used to find the cause of excessive or irregular uterine bleeding.

This bleeding can occur at the time of your period or between periods. The bleeding can be caused by hormonal imbalance, overgrowth of the lining of the uterus (endometrial hyperplasia), polyps, fibroids or uncommonly, by cancer of the cervix or uterus.

If your doctor suspects a hormonal imbalance as the cause of your bleeding, he or she will try to time the D-and-C after the mid-point or ovulation phase of your cycle, in order to best analyze the influence of your hormones on the uterine lining. The hysteroscope exam is usually best performed earlier in the cycle before ovulation has occurred.

According to Dr. Patrick Taylor, the hysteroscope should replace the D-and-C as the best means to detect the cause of abnormal bleeding, since the D-and-C will miss up to 25 percent of the causes of abnormal bleeding.

UTERINE FIBROIDS AND POLYPS: Both the hysteroscope and the D-and-C can be used to diagnose uterine fibroids (benign tumours that grow outside, inside, or within the wall of the uterus) and to diagnose uterine and cervical polyps (tube-like protuberances from the uterine wall or cervix, also benign).