Sexual Activity Before Dilation and Curettage (D&C)
It is generally advisable to abstain from sexual intercourse in the days immediately preceding a scheduled D&C procedure, though no explicit guideline directly addresses this specific timeframe.
Rationale for Abstinence Recommendation
The primary concerns with sexual activity before D&C relate to:
Infection risk: Sexual intercourse introduces bacteria into the vaginal canal and potentially through the cervix, which could theoretically increase the risk of post-procedural infection, particularly endometritis or pelvic inflammatory disease following instrumentation of the uterus 1.
Pregnancy uncertainty: If there is any possibility that the indication for D&C might be reconsidered or if pregnancy status is uncertain, recent unprotected intercourse could complicate the clinical picture. Guidelines emphasize the importance of being "reasonably certain" a woman is not pregnant before certain procedures 2.
Cervical trauma: While uncommon, sexual activity could theoretically cause minor cervical irritation or trauma that might complicate the procedure, particularly in patients with risk factors such as nulliparity or postmenopausal status, which are already associated with higher complication rates during D&C 1.
Clinical Context and Risk Factors
The overall complication rate of D&C is low (1.9%), with uterine perforation occurring in 0.9% of cases 1. However, certain patient characteristics increase intraoperative complication risk:
- Retroverted uterus (significantly associated with complications, p=0.008) 1
- Postmenopausal status (p=0.003) 1
- Nulliparity (p=0.03) 1
Practical Recommendation
Advise patients to abstain from sexual intercourse for at least 24-48 hours before their scheduled D&C procedure. This conservative approach minimizes any theoretical infection risk and ensures optimal procedural conditions. If the patient reports recent unprotected intercourse and there is any uncertainty about pregnancy status or the indication for the procedure, ensure pregnancy testing is current before proceeding 2.
Important Caveats
- No high-quality evidence specifically addresses the safety window for sexual activity before D&C 1, 3, 4
- The recommendation is based on general principles of infection prevention and procedural preparation rather than direct evidence of harm
- If emergency D&C is required (such as for hemorrhage), recent sexual activity should not delay necessary treatment 5