A Melbourne woman’s dream of motherhood has been cast into doubt after a routine surgical procedure left her uterus scarred, prompting renewed calls for tighter regulation of outdated practices in Australian women’s health care.
Lily Johnstone, of Melbourne, underwent dilation and curettage (D&C) following a miscarriage two years ago. She now faces the possibility she may never be able to carry a child to term, after discovering the procedure caused Asherman’s syndrome – a condition where scar tissue builds up inside the uterus. “At the moment it kind of feels like that’s been taken away from me, so it’s highly sad,” Ms. Johnstone said.
D&C procedures are commonly performed to remove pregnancy tissue after miscarriage, abortion, or childbirth. Though, 1 to 2 percent of women who undergo a D&C develop Asherman’s syndrome, according to medical reports. The condition can lead to changes in menstruation, painful periods, difficulty becoming pregnant, increased risk of infection, and complications during future pregnancies.
Ms. Johnstone’s case is not isolated. Advocates and a senior obstetrician are now pushing for the collection of data on Asherman’s syndrome and the practices that contribute to it, citing concerns about the continued use of sharp curettes – a looped metal tool with a cutting edge – in D&C procedures.
The World Health Organization (WHO) strongly recommends the use of suction curettes – a blunt plastic tool – for D&Cs, as they are less likely to cause uterine scarring. Despite this recommendation, the Australian Broadcasting Corporation (ABC) reported finding evidence of women in at least four Australian states who recently underwent D&Cs using sharp curettes at both public and private hospitals.
Obstetrician Thierry Vancaillie, who specializes in treating Asherman’s syndrome, described the sharp curette as a “museum piece,” stating This proves a diagnostic tool, not intended for treating miscarriages. He explained that sharp curettes can injure the uterus and may fail to remove all tissue, potentially leading to infection or scarring. “The sharp curette is a diagnostic tool. It’s to obtain a uterine cavity sample for histological analysis. It’s not intended to treat miscarriages,” Professor Vancaillie said.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) issued clinical guidelines in March 2026 stating that sharp curettes should be avoided in D&Cs following miscarriage. However, RANZCOG currently has no guidelines regarding postpartum D&Cs.
Naomi Cate, co-founder of Asherman’s Australia, expressed frustration that regulators have not yet changed the rules regarding the use of sharp curettes. She herself was diagnosed with Asherman’s syndrome after a postpartum D&C she was later told was unnecessary. “When [women] agree to that D&C, we desire to know that they’re getting the safest possible treatment,” Ms. Cate said. She likewise revealed she consented to a D&C using a suction curette, but a sharp curette was used instead, requiring her to undergo further surgery to repair the damage before attempting to become pregnant.
The Therapeutic Goods Administration (TGA) currently classifies most sharp curettes as class 1 medical devices, which does not require reporting of adverse events. This classification has drawn criticism, with Shadow Minister for Health Anne Ruston calling it “ridiculous” that the TGA claimed it could not change the classification without receiving information about adverse events, when the current classification does not require such reporting. “We’re talking about women who suffer lifelong injury, women who live with pain for the rest of their life, women who have had their chances of having a family taken from them by this procedure,” she said.
The TGA stated late last year that it asked all suppliers of sharp curettes to include a warning about the risk of Asherman’s syndrome in their instructions for use.
RANZCOG president Dr. Nisha Khot stated she would like to see all D&Cs performed using suction curettes whenever possible, but acknowledged that ultrasound machines and trained clinicians are not universally available. She also emphasized the need for an Asherman’s syndrome registry and increased funding for research, citing a lack of data as a significant problem. “We have very few registries for anything to do with women’s health,” she said.
Ms. Johnstone said she wasn’t informed of the potential risks before her procedure and remains hopeful that surgery can repair the scarring in her uterus. She is currently working four days a week due to the emotional toll of her experience.
