During the Procedure

• Anesthesia

• Local anesthesia: If you have a local anesthetic, you will lie on your back in the standard pelvic examination position: legs apart and your knees drawn up. Your doctor will insert an instrument called a speculum into your vagina to hold the vagina wall apart. The doctor or assistant will then clean the inner and outer vagina, including the cervix, with a cleaning solution. The doctor will then steady the cervix with a clamp and inject a local anesthetic into the cervix on either side. This is called a paracervical block and relieves pain from the dilating of the cervix. It does not numb any of the rest of the body.
  
  
• Spinal anesthesia: A needle is placed in the lower back, usually while the patient is sitting up. Anesthetic is injected through this needle into the spinal fluid that surrounds the spinal cord. This causes numbness usually from the level of the belly button on down. It wears off in 1-3 hours.

• General anesthesia: If general anesthesia is given, you will not be aware of anything including the cleaning step, after you lose consciousness. You will lie on the table with an anesthesiologist or nurse anesthetist at your head. You may be given an injection of medication to relax you and to dry up any oral secretions. You will then receive an intravenous fast-acting anesthetic and immediately fall asleep for the procedure.

• 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 The rod is left in place for a moment, then withdrawn and replaced by a slightly larger rod.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. If you are under local anesthesia, you may experience crampy discomfort caused by stretching of the cervical muscles to accommodate the rods. Another method being used with increasing frequency is to insert laminaria tents (cigarette-shaped pieces of a special dried seaweed) into the cervix 8-20 hours before the procedure. The laminaria absorb water from the tissues and swell up, slowly distending and dilating the cervical canal. This is less traumatic than using the metal dilators.
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• 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.
  
  
• If under local anesthesia, you will probably experience a tugging sensation deep in your abdomen as the curetting is performed. If this is too painful, you should tell the doctor, who may then order pain medicine.

• The entire procedure, including curettage takes about 20 minutes. At the end, you may have cramps. This may last about 30 minutes.