Home > She Blogged WHAT? > Why Not? Blogging My D & C

Why Not? Blogging My D & C

Blame it on Abel, who blogged his vasectomy, and Janet, who blogged her mammogram. Also blame Drugmonkey and Physioprof, who along with Abel, Janet, and others encouraged me to Blog My D&C. Yep. So here goes.

It all started innocently enough back in May with my annual exam. First appointment. My nurse practitioner was bothered by my history: no periods since September 2006, followed by the sudden surprise! of brief bleeding episodes in February and mid-May. Various doctors of mine have been debating as to whether I am in menopause, or I just have screwed up hormone levels that need to be straightened out. The nurse practitioner is on the menopause side, and so the two bleeding episodes, from her point of view, warranted taking a uterine biopsy.
Note to readers: If anyone ever wants to biopsy your uterus and says “It doesn’t hurt much, just a little cramping,” do NOT believe them. Insist on some sort of sedative. Though I was told that it would be just “mildly uncomfortable” with “maybe a little cramping”, I nearly elevated off the table from the astonishingly intense pain (followed by cramping on and off the rest of the day). And it was all for naught; she was unable to obtain a biopsy sample. She decided not to proceed with the exam any further at that point. She ordered a vaginal ultrasound to get a look at the condition of the uterus, and asked me to come back for the exam after getting the ultrasound.
So I scheduled the ultrasound (second appointment), which was uncomfortable but not painful, and then returned for the exam and to discuss the results. Third appointment. The results showed some thickening of the uterine lining, and she recommended a D&C, or dilation and curettage, which would be performed by a gynecologist on staff I’d yet to meet. (This site has a great description of D&C, reasons for having one, etc.)
I set an appointment with him (fourth appointment), and we discussed my history and the ultrasound results. Together we concluded that a D&C was the prudent course of action. He explained that the procedure would involve dilation of the cervix to allow entry into the uterus with various implements, including a camera that would let him take a look at everything (hysteroscopy). I would be sedated, and he promised that recovery would not be bad at all – “just a little cramping and some spotting of blood”. Naturally, I was suspicious of this!
There was, of course, a pre-op appointment (fifth appointment). A very reassuring nurse took my history, list of meds, and allergies. She decided she needed to get an EKG on me because of some other stuff in my medical history, just to be safe; it was fine. Then it was time to draw blood. Sadly, my veins did not wish to cooperate. In fact, they had gone into hiding. She called in the lab technician, who draws blood all day long; she also could not find any veins. She finally drew blood from a spot on the inside of my arm about three inches below my elbow. Do not let anyone do this to you, especially if you take Plavix. Otherwise, you will end up, as I did, with a two-inch long, one-inch wide, garish purple bruise. They advised me to drink plenty of water the day before the procedure, to help beef up the recalcitrant veins.
Interestingly, I was not asked to stop taking Plavix before the procedure. Apparently the risk of extensive bleeding is slight compared to the risk of going without the Plavix for protection against stroke.
Pre-op instructions included nothing to eat or drink after midnight, take morning meds with a minimal sip of water, remove all jewelry including piercings, and wear loose clothing. I found it both funny and sad that women had to be told not to wear high heels. Who would want to walk around on high heels after having someone poke around inside your uterus? Apparently, enough women do, that an admonishment against this behavior needs to be included in the pre-op instructions. Another pre-op instruction was the requirement to have someone to drive me home, and stay with me for 24 hours following the procedure. The sedation would include a combination of three drugs: propofol, versed, and fentanyl. Sedation, amnesia, analgesia. That works for me!
I was told to report to outpatient surgery at 6:30 a.m. The very nice pre-op nurse had scheduled me first in the day to minimize my fasting time, so as to also minimize the chances of triggering a migraine from going without food for too long. Yes, she was a migraine sufferer, too. If you are a migraine sufferer and have to fast for a procedure, don’t wait for a kind nurse to help you out; ask for your procedure to be scheduled as early as possible.
I got up at 5 a.m. to shower and at the last minute decided to shave my legs, too. Didn’t want anyone in the operating room gossiping about those hairy-legged feminists. Mr. Z and I were at the outpatient surgery waiting room at 6:15 a.m., which was a mistake. Being early gave me extra time to work up the anxiety I was experiencing. They really should have someone to greet you at the door who says, “Welcome to the outpatient surgery waiting room; here’s your valium!” I registered, with photo ID and insurance card, and was informed that my insurance required a $150 copay upfront. Good thing Mr. Z had his wallet with him because I had not brought mine, seeing as how they instructed me to leave all valuables at home. What would you do if a neighbor or friend had brought you the hospital? Ask them to pay for you? There had been a message left on my phone the previous day from someone at the hospital “regarding your insurance”. Too bad they didn’t call me till 4:30 pm on the day before surgery, and I didn’t get the message in time to call them back. The person didn’t say anything about copay. Perhaps they could have included that info in the phone message? Just sayin’.
So – goodbye to Mr. Z and back into the prep room or whatever it is called. My anxiety level went up another notch, but a very nice nurse soothed me a bit. Off with all the clothes, on with two of those lovely hospital gowns – the first with the opening to the back, second with the opening to the front, like a bathrobe. Tres chic. And a pair of those fab hospital slipper socks, with the non-skid treads on the bottom. Upside: warm toes. Downside: no one gets to see my pedicure.
The very nice nurse spoke calmly and slowly to me, explaining that the anesthesiologist would come see me and then the doctor, and then I would go into the surgery room. The anesthesiologist flounced over to my corner, apparently bored and angry. She spoke so fast I could only understand every third word or so. Her obvious lack of interest in communicating with me and apparent disdain for her required task frightened me into silence. I was not happy that this was the person who would be in charge of my breathing, but I felt powerless. She was there for maybe a minute and then was gone. I was angry with her for being such a jerk, and angry with myself for not having the nerve to ask her to slow down so I could understand her. I mean, even if I hadn’t been mentally impaired by anxiety it would still have been impossible to catch anything she said.
Next the doctor came to speak with me, and he was all that the anesthesiologist was not: calm, friendly, reassuring, he spoke slowly and asked if I had any questions. And waited for me to think of questions. He asked for my permission to talk to Mr. Z after the procedure, and then asked if I wanted a copy of any photos he might take during the procedure. Photos? Ooh, yes please!
Then suddenly it was time to go into the operating room, and my anxiety level spiked. There were four or five people in the room; I can’t tell you what they all did as I was too anxious to take note, but they were very, very, very kind people. They were aware of my family history – I have a brother who, thirty years ago, was ruined during a routine hernia operation when he was not given enough oxygen; he’s been in a nursing home ever since. The people in this operating room offered their sympathy, and reassured me. They told me that the whole time I would be sedated, blood pressure, oxygen level, and heart rate all would be constantly monitored.
Before I got on the table in the operating room, I had to take off the “bathrobe” gown, leaving only the one that opens in the back. Then I had to lay down on my bare back with the gown just covering me. The table had a hole right about where your butt would go – I had to position my butt right at the edge of this hole. I didn’t see any stirrups but I’m presuming they had to be there somewhere. Someone strapped a large belt over my waist, and my arms were taken to either side. At this point, as in my appendectomy and gallbladder surgeries, it felt weirdly like being put on a cross. Maybe that’s just a peculiarly Catholic anxiety? One arm is devoted to monitoring equipment, I think, and the other goes for the iv. The whole setup leaves one feeling particularly vulnerable. By now I was shaking with anxiety, and tears were leaking out the corners of my eyes. One of those nice people took the edge of blanket covering me and gently wiped my eyes. That little gesture meant a great deal to me. The first prick of the needle in my hand burned – a local anesthetic, I was told – and then I felt something cool and it’s a bit uncomfortable, and then…
…hello! It’s the recovery room! w00t! I’m still alive! And not brain-damaged! Whoa, but those are some mighty unpleasant cramps.
A nurse brought something that looked like a pool float, several long tubular sections joined together. She placed it on me and draped a blanket over top – soothing warmth all over. I think I heard someone say they inflate the pool float-y things with the hot air from a blow dryer, but possibly I just dreamed that in the drug haze. My thanks to whoever engineered that rig – it’s very relaxing. Also, they gave me percocet (after a little ginger ale and a few crackers). Cramps, begone!
Here is what I missed thanks to the sedation:

Dilation (the first step): While grasping the cervix with a clamp, the doctor will pass a thin, flexible piece of metal called a sound to determine the depth and angle of the uterus. These measurements allow the doctor to know how far into the uterus the curette can be safely inserted. The usual method of dilation is to insert a thin, smooth metal rod gently along the vaginal canal and up into the tiny cervical opening. The rod is left in place for a moment, then withdrawn and replaced by a slightly larger rod. This process is repeated until the cervix has expanded to about the width of a finger. This method takes about 10 minutes…
Hysteroscopy and curettage (the second step): After dilation, your doctor holds the vagina open again with the speculum. The doctor may also reach into the cervix with a tiny spoon to obtain a specimen of the cervical lining. At this point, the hysteroscope is usually inserted into the uterus so that the doctor may look at the inside of the uterus. The doctor may see fibroids, polyps, or overgrowths of the endometrium. At that time, instruments may be inserted through the hysteroscope and biopsy, or removal, of these things may be accomplished.
The doctor will now place a slightly longer and larger curette through the dilated cervix and up into the uterus. This is a metal loop on the end of a long, thin handle. With steady, gentle strokes, the doctor will scrape or suction the uterine wall. This tissue is sent to the lab for analysis. When the curettage is completed, the instruments are removed.

Here’s one of the pictures from my hysteroscopy. Don’t ask me to interpret for you.


I can’t remember how long it was before they decided I could move from the bed in the recovery room, to a chair, or what the decision was based on, but pretty soon I was in the hospital version of a Barcalounger. They gave me pads to sop up the blood but surprisingly (to me) there really wasn’t any blood flow. Before I got dressed, the nurse gave me a wet towel to clean myself; there apparently was a fair amount of blood on me from the procedure, but I wasn’t bleeding. Mr. Z was brought in to hear the post-op instructions since I obviously couldn’t be trusted to remember them. Then he went out to bring the car around to the exit, I got wheeled out to meet him, and we were on our way home. It was 10 a.m.
Most of the rest of the day was spent lying around in a foggy post-sedation haze, while Mr. Z brought me this and that to eat, generally fussed over me, and kept asking me if I needed anything. Mr. Z rawks. I experienced some uncomfortable cramping throughout the day, but it was not intolerable. They sent me home with percocet for post-operative pain, and it was certainly adequate. Though I was told I might have bleeding which could be heavy, and could last up to two weeks, I have barely spotted. The recovery has been much easier than I expected. The doctor told me, and Mr. Z, that “everything looked good” and that he did not see anything of concern.
I have a follow-up appointment with the doctor in a week, at which time I assume I’ll hear about any biopsy results. This will be the sixth appointment in this saga, plus the procedure day itself. It is obvious that attending to your health takes serious amounts of time. How would a woman with a full-time job and very limited vacation or sick leave manage six appointments and a whole day off for the procedure, just to deal with ONE health issue?
Post-op instructions included no heavy lifting for two weeks, and no douching, intercourse, or tampons for two weeks. I specifically asked about gardening and was told “no” for at least the next week or so. So of course, it rained like hell last night, blowing out the heat and humidity we’d been stuck with for days, leaving us with a day of perfect weather, and garden soil loosened by the rain, just begging to be weeded. By the time I can get back to the garden the weeds will be knee high and the soil baked dry again, I’m sure. I was casting longing looks at the garden all morning. Then, after what I thought was some relatively minor physical activity, I experienced another bout of cramping, so I decided against sneaking out to weed the garden without telling Mr. Z. I do not like being kept out of my garden. I will be glad when this time is over.
And that’s it! Now I am officially one of those people who shares every intimate detail of their lives with total strangers on the internet. You know, just like I promised myself I would never do. If you had asked me, when I first took up blogging, whether I’d be posting pictures of the inside of my uterus on my blog, I’m pretty sure I’d have answered “what the hell are you talking about?” And yet, here we are. Just don’t tell my mom.
A side note on women and gynecological procedures:
Many women are survivors of sexual abuse or sexual assault. For them, even routine gynecological exams can be a traumatic experience. A procedure like a D&C, which places one in an even more vulnerable state, can be even more difficult to undergo. It’s important to be able to communicate openly with your health care provider about your history. A good gynecologist will talk with you about your fears and explore ways to reduce anxiety. These can include simple techniques like making sure that the health care provider tells you explicitly everything that he or she will do at each step before proceeding, and checking in with you periodically to see how you are doing. If you find it difficult to advocate for yourself in this way, you may want to take a trusted friend with you to your exam. Most gynecologists these days are aware that sexual abuse and sexual assault are all-too-common experiences for women, and that they can affect a woman’s ability to tolerate exams and procedures. But if you run into someone who is not sympathetic, don’t just put up with it, or worse, avoid taking care of your health because of it. Find a new doctor.

Categories: She Blogged WHAT?
  1. July 24, 2008 at 9:19 pm

    Zuska, you rock.

  2. July 24, 2008 at 9:28 pm

    Mr. Z rawks, but so do you! I’m glad you shared this.

  3. July 24, 2008 at 9:31 pm

    Wow, that procedure freaks me out reading about it! Good job!

  4. July 24, 2008 at 9:53 pm

    I really admire/am in awe of how you captured an experience that would’ve had me sobbing in the corner. Two little slits in my scrotum are absolutely nothing compared to a D&C and yet hundreds of thousands of US women go through this annually with little attention or fanfare. The majority of these procedures are diagnostic with the potential for revealing bad news. I am glad to learn that the majority of the medical team were cognizant of the anxiety you felt.
    I especially appreciated how you finished with the commentary about special issues of women survivors of sexual abuse/assault.
    I am certain that many women who stumble upon this post will be grateful to you for writing it. I wish you a speedy recovery and a quick return to gardening.

  5. July 24, 2008 at 10:37 pm

    Wow, you are so brave – way braver than I am. You go, girl. And I too love that you ended with the commentary on gynecologists. . . seriously, finding someone you trust and are comfortable with is important no matter what your personal history is. As someone who for years saw gynecologists and NPs I wasn’t comfortable with, I finally have one who doesn’t make me feel weird or stressed. It not only reduces my anxiety, but makes those icky procedures much less painful. The body really is responsive to the brain.

  6. July 25, 2008 at 2:59 am

    Great post, Zuska. I think that patient narratives like this should be a part of medical education.
    If I remember correctly from my Ob/Gyn clerkship, IMG_004 is a nice view of the junction between the fallopian tube and the uterus.

  7. July 25, 2008 at 7:12 am

    Best wishes for a speedy recovery, Zuska!
    This is a brave post, and I’m sure the information will be valuable to a lot of worried women.

  8. Super Sally
    July 25, 2008 at 9:36 am

    Thanks for sharing this.
    Some years back I had a D&C, going after known fibroids. Since Duke was unable to drive me, I scheduled it for a holiday week when one of the kids was home and available to get me there and back. However, I did not expect him to have to make any decisions with the doctor during the procedure.
    Given a choice between an epidural (after which they recommend an overnight in the hospital to make sure you are competent to ambulate) or a saddle block (local), I chose the latter. The doctor was dubious, but having had long hard labors to produce 4 children I knew my pain tolerance.
    It worked. During the procedure I could feel pressure, but no real pain. Recovery was OK (I fixed dinner that night). All-in-all a necessary inconvenience to stop the heavy bleeding that had become part of my life.
    The no gardening is to guard against you lifting, or even pulling weeds which might strain your back muscles that were traumatized by the procedure.
    Hope you are well past it by now.

  9. Bee
    July 25, 2008 at 5:57 pm

    Cool blog usage!
    I had this procedure done about three years ago, in Canada. I live in a rural area, and there is a gynocologist who comes out with a nurse once a month to the local six GP medical centre. Or you can go to another doctor if you prefer, but for that you have to go into the city an hour’s drive away.
    There were a few differences, but not many. My gynocologist did the same business of trying for a biopsy sample without a sedative, but desisted immediately, as soon as I expressed that I was hurtin’. I was fifty three at the time and hadn’t had even any spotting for two years (until then), so was considered menopausal. So I was surprised to be given a pregnancy test first thing – standard, apparently.
    Only one of my arms was used for anything, at least while I was still conscious, and the anaesthesiologist was kind and even humourous. I woke up with an oxygen mask on my face, and had to breathe for about five minutes to get my oxygen levels up before being allowed to leave with a friend. Had very little pain or bleeding.
    At my follow-up appointment, I got the good news that nothing was wrong at all, and when I pressed for a reason for the bleeding, which had felt and proceeded exactly like a normal, light menstrual period, was told it may very well have been just that. Don’t give up on the birth control too soon, people.
    So, two appointments and the procedure.

  10. July 26, 2008 at 8:45 am

    I had a hernia surgery three years ago, and I felt a twinge of recall at the bewilderment of being wheeled into the OR and seeing so much commotion going on. I had toured the very same OR with my son prior to my surgery as part of a pre-op pediatrics program at the hospital. I just didn’t remember them discussing how many people would be involved.
    Then the anesthesiologist came in and gave me his full, caring attention. He prepped my arm, talked baseball while working, looked me in the eye when explaining what he would be doing while I was under. He then inserted the IV, and I blinked. Or so it seemed, but when I opened my eyes I was in a comfy chair with a blanket.
    While appreciate the surgeon and the remainder of the staff in the OR, the anesthesiologist made all the difference in my experience.
    I am sorry you had that experience with your anesthesiologist, Zuska. Thanks for blogging this, and also for bringing up the final segment amount sexual abuse trauma and advocacy.

  11. yeesh
    July 28, 2008 at 12:22 am

    Zuska, get well soon!

  12. Cathy
    July 28, 2008 at 2:51 am

    Hey, I beat you. Last year I blogged my radical hyst. for invasive cancer. Actually I blogged the pap, colposcopy, D&C and hysteroscopy also.
    you are right about those non-painful biopsies. I remember the day I had my Colp and biopsies. The plan was that he would take one or two and “they will not hurt.” Well he took 12 and let me tell you, thats alot of pain involved. The first 4 I tolerated pretty well and after that each one was more and more painful until I thought I would pass out. the nurse thought I was going to. We were both begging him to stop at about number 10.

  13. July 28, 2008 at 4:01 am

    Z, I reposted my hyst and cancer post for you if you would like to read it. http://cathysplacetoblog.blogspot.com/2008/07/myths-lies-and-misconceptionsa-story-of.html

  14. sea creature
    July 28, 2008 at 6:00 pm

    thanks for blogging this. For some reason California Kaiser (at least in the early 2000’s) does not do general anesthesia for D & C’s & hysteroscopies. I was awake for mine, which ended up being just a hysteroscopy & biopsy (fibroids). I sort of sat up and looked at the monitor at the inside of my uterus while they looked around. While I would never say the experience was cool (lots of crampiness) the inside of my uterus was pretty neat. Also I got to see the fibroid that was causing me to bleed to the point of having a transfusion.

  15. July 29, 2008 at 10:56 pm

    Wow, Zuska. You amaze me more every day. I think it’s so important that we share things like this in order to demystify (and destigmative) the female body and the appropriate medical procedures to care for it. Thanks for sharing.

  16. July 31, 2008 at 4:54 pm

    I want to thank all of you so much for commenting here. I was fairly nervous about posting this, precisely because of that whole stigma about “wimmin’s parts should be kept sekrit” stuff. The responses are very heartening.
    And Susannah, I am so glad you commented! I do hope you will be able to speak up, and that speaking up will help you manage the fear and anxiety a little better. If your doctor is not receptive and helpful when you speak up – find another doctor!

  17. anita
    August 2, 2008 at 10:24 am

    Thank you so much for sharing your experience. I am 48, had some unexplained bleeding and an inconclusive endometrial biopsy. So next Friday, I too, am scheduled for a D&C. My first surgery every, and I am quite nervous.
    I am planning to ask for MAC sedation instead of a general. The thought of being put completely out terrifies me.
    Did you receive your results?

  18. december julep
    January 7, 2009 at 1:41 pm

    I am thankful I found your blog today. I am scheduled for my own D&C w/ hysteroscopy in a couple of weeks. My biggest problem is fear of the anaesthesia (having never had any) and the fact that I am anxious re: anything medical lately. This all started for me a bit after my sister died last year. I would like to put it off, but the ultrasound showed a polyp and after agonizing on this for a month, I think I just have to get through it and put it behind me.
    The clinical information is out there, but your blog told me what a woman going through this really feels. I believe I will be thinking of you as I calm myself before the procedure. Power to the Z!! Thank you for your honesty. 🙂

  19. February 9, 2009 at 11:42 am

    Caryll, thanks for reading and I’m glad we all could be of some help. I wish you the best of luck and, if you are reading this comment, come back and tell us how things went for you. Don’t be afraid to ask questions all along the way and ask them to slow down and repeat stuff and give you time to take a breath and catch up if things are getting really traumatic for you. Hang in there! You will make it through okay.

  20. Myra
    April 16, 2009 at 12:37 pm

    I know it’s been awhile since you wrote this blog, but I wanted to thank you anyways. I’m scheduled for a D&C and am very nervous. Your account is helping to soothe some of my nerves. It’s good to hear other women’s accounts of making it through this. Your story also made me aware that they didn’t even think to warn me about the “no heavy lifting” bit, which is going to be a major problem for me as it’s REQUIRED for the job that I have to do only 4 days after the operation. Your story is the first time I’ve heard of this post-op requirement. I’m going to have to discuss that little oversight with the doc. They’ve been rushing me towards doing it because I’m moving out of the state within 3 days of having it done. They even want to go ahead despite a yeast infection, which worries me about the spread of infection. The doctor wanted to do it only under local anesthesia, which I discovered actually only numbs your cervix and NOT your uterus. All because “oh it won’t be that bad that you need to be knocked out.” The more I read other’s accounts of D&C’s, the more I become convinced that I’m in the right to insist on general anesthesia. I don’t want to be awake for that. And I say this despite being scared of IV’s (VERY painful past IV experiences). I’m going to be thinking of what you wrote to help calm myself down while at the hospital. It’s definitely reassuring to think of all the women who have gone before. Thank-you very much for sharing! I’m glad to hear that everything turned out fine for you in the end!

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