The best early abortion method: the Aspiration Procedure

Posted by drjoan on Sun, Nov 11, 2010 @ 9:34 PM

The Aspiration Procedure is the most safe, simple, and natural way to end early pregnancy. Unfortunately, most women have never heard of it. This gentle non surgical procedure is completed in less than 5 minutes in a private examination room. There is immediate recovery. Other names for the Aspiration Procedure are: Manual Vacuum Aspiration, “mini-vac,” and Menstrual Extraction. The Aspiration Procedure was developed in the 1970’s.

What is it? The Aspiration Procedure is handheld device that applies gentle pressure to “bring down” the early pregnancy tissue. The doctor inserts a speculum (like a pap smear). She numbs the cervix with lidocaine. She inserts a thin cannula (like a straw) through the natural opening of the cervix. She attaches the Aspiration device which provides gentle suction. The menstrual lining and early pregnancy tissue naturally detaches from the uterine wall, and into the device. The uterus contracts in response to the procedure, so there is some natural healthy period-like cramping that resolves within a few minutes. There are no major complications because there is no scraping, no electric suction, and no general anesthesia. Within 10 minutes of starting the procedure, you feel completely better and are able to resume your normal activities.

Ideally, this procedure should be offered in a private, discreet doctor’s office. You should have a scheduled, one hour appointment. You should be able to eat and drink normally before and after your visit. You should be in a dedicated examination room. You should be able to bring a companion to be with you the entire visit. You should be able to meet with your doctor and discuss your options.

Sound too easy? Perhaps that’s the issue. This simple procedure has the potential to take all of the punishment and politics out of ending early pregnancy.

Where do you get it? The Aspiration Procedure is endorsed by the World Health Organization as the safest early abortion method, yet it is extremely difficult to find a doctor who offers it. If you can get to New York City to an Early Options® medical office it is certainly worth your trip. At Early Options® you are guaranteed to have a woman doctor, a scheduled appointment, a private examination room, and your companion is welcome to stay with you the entire visit. There are a few other family doctors that offer the Aspiration Procedure in the United States (

Beware of large abortion clinics that say they offer the Aspiration Procedure. Make sure to ask:

  • Does the doctor scrape the uterus? (they should not).
  • Is the procedure offered in a private examination room? (it should not be in an operating room)
  • Am I taken to a recovery area? (this should not be necessary)
  • Do I have an individual appointment or are other women scheduled at the same time?
  • Can I eat and drink before my visit? (you should be able to)
  • Can my companion accompany me for the entire visit? (they should be able to)
  • How long will I be in the clinic? (should be less than 2 hours).

The Aspiration Procedure has the potential to transform early abortion into mainstream medical care. Doctors could learn to provide these services as part of their residency training. Women could access early abortion services at their family doctor’s or gynecologist’s office. Women and doctors who access or provide abortion services could no longer be targeted. More women need to know and advocate for the development of this procedure.

Ask Doctor Joan: Manual Vacuum Aspiration Abortion

Posted by drjoan on Sun, Oct 10, 2009 @ 10:26 PM

Questioner: Jen
Subject: Is the Aspiration Abortion Procedure the same as Manual Vacuum Aspiration?
Date Asked: 2009-10-12 18:35:47
Date Answered: 2009-10-12 18:49:36 on

Dear Doctor Joan,
I just learned about the Aspiration Abortion Procedure.  I think this would be the best option for me because I am only 3 weeks pregnant. I heard the Aspiration Procedure is the best early abortion method.  Is it the same as Manual Vacuum Aspiration or Menstrual Extraction?  How is it different from surgical abortion? I am trying to find a doctor who offers Aspiration Abortion.  How do I find a doctor? Why is it so hard to find a doctor who does Manual Vacuum Aspiration?  This is very confusing.
Thanks for taking the time to answer my questions.

Dear Jen,
Manual Vacuum Aspiration (MVA) is the most safe and simple early abortion method.  It is also known as the Aspiration Abortion procedure, “mini-vac” and Menstrual Extraction.  Technically, Manual Vacuum Aspiration is a medically advanced version of Menstrual Extraction.  Menstrual Extraction was developed in the 1970’s, and was used by feminist health groups.  Menstrual Extraction was so simple that women used to do it on each other in their own homes!

Manual Vacuum Aspiration was later developed by an organization called IPAS, dedicated to international access to safe early abortion procedures.  In the United States, Manual Vacuum Aspiration was introduced to the medical mainstream abortion community in the early 90’s.  Since then it has been used by the most progressive abortion doctors.  Unfortunately, most high volume abortion clinics are still using surgical abortion, even though it is too invasive for ending early pregnancy.

Manual Vacuum Aspiration is safer than surgical abortion for three main reasons: there is no scraping; there is no electric suction; and there is minimal discomfort so there is no need to be put to sleep.  The Aspiration Abortion Procedure can be completed in a regular doctor’s examination room (not an operating room) and takes only a few minutes to complete.  It is nonsurgical and noninvasive.  Within minutes, there is complete recovery.  Women can leave the office and resume their normal activities.

Why is it so difficult to find doctors who offer the Aspiration Abortion Procedure?  Unfortunately, most abortion clinics do not offer it, or offer it in the same way they offer surgical abortions – in an operating room setting.  Menstrual Extraction is no longer practiced since Manual Vacuum Aspiration was developed.

Click here for the best resource for finding a doctor who performs Manual Vacuum Aspiration. These offices practice Manual Vacuum Aspiration correctly – in a private examination room where companions are welcome, with no uterine scraping, and in scheduled private appointments (not a clinic setting).

I hope you find this helpful,

Doctor Joan
Early Abortion Specialist

How Menstrual Extraction became the Aspiration Abortion Procedure

Posted by drjoan on Wed, Oct 10, 2009 @ 8:38 PM

imagesI am a pioneer, educator, and advocate of the Aspiration Abortion Procedure (Manual Vacuum Aspiration) for ending early pregnancy and for treating miscarriage. I have been providing the Aspiration Procedure for over a decade to thousands of appreciative patients. I continue to be astounded at how few people know about this simple procedure that can be completed in a regular doctor’s office in a few minutes. The procedure has an interesting history, and I thought it would be valuable to summarize this for those who have learned about this amazing device.

The Aspiration Procedure (Manual Vacuum Aspiration) is the most safe, simple, and natural procedure to end early pregnancy. The clinician inserts a thin cannula (straw) through the natural opening of the cervix. She then attaches a small handheld device that applies gentle pressure. This pressure or suction then releases the menstrual lining and early pregnancy tissue into the device. Within minutes, the pregnancy is over, and the patient can return to her normal activities. The Aspiration procedure is best used under 10 weeks of pregnancy, but can be used later depending on the clinician’s judgment.

The Aspiration Procedure is considered a non surgical abortion procedure, because there is no scraping, so there is no entry into the uterine wall. The device simply causes a natural release of the thickened menstrual lining, which would have shed with the menstrual period. Compared to surgical abortion, there are no major complications, because there is no scraping and no strong electric suction.  There is minimal discomfort so that the procedure can be completed with a safe local anesthetic.

Manual Vacuum Aspiration is a modernized form of an interesting procedure called Menstrual Extraction. It has its history in the feminist “take back your health” movement. It is worth learning about the history of this remarkable procedure:
American feminists Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method American feminist activist Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method of removing a woman’s menses to avoid an inconvenient period or, more importantly, to end a pregnancy at an early stage. They introduced their work to fellow activists in Los Angeles in the same year the Roe v. Wade case was in court, before the legality of abortion had been established. The two activists wanted to create a safe, simple, affordable means of ending a pregnancy at a time when U.S. law and culture severely limited women’s legal and medical options concerning reproductive health.

Rothman fabricated a device called the Del-Em, constructed of easily obtainable laboratory supplies: a jar, rubber stopper, plastic tubing, a cannula, a one-way valve, and a syringe. Downer and Rothman organized self-help clinics for women and demonstrated the uses of the Del-Em. These self-help groups were formed not simply as an introduction to menstrual extraction, but as a broader forum within which women could educate themselves and each other about their bodies and reproductive health in an informal, nonmedical setting. Self-examination with a speculum was one technique employed at the meetings to demystify the female reproductive anatomy. It was within this context of underground, politically oriented sexual health education that Rothman and Downer developed and disseminated the technique of menstrual extraction.

To demonstrate menstrual extraction at self-help meetings, a woman about to begin her period (or who suspected she was pregnant) would volunteer to undergo the procedure, while the other women would watch. The procedure involves the insertion of a flexible 4mm cannula into the os, or cervical opening. The cannula is attached to a long piece of plastic tubing connected to one of two small openings in a rubber stopper covering a jar. A second piece of plastic tubing is connected to the other hole in the stopper; a one-way valve is attached to this piece to control the flow of the contents and attached to a syringe. Once the kit has been assembled and the cannula inserted into the cervix, the woman undergoing the extraction pumps the syringe to gently suction the contents of her uterus, which are caught in the jar. Because she is holding the syringe, she can control the speed and pressure of the extraction, moving at a pace she finds comfortable. The extraction process could be finished in about five minutes.
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In the early 90’s, Manual Vacuum Aspiration entered the mainstream medical world in the United States. Jerry Edwards published a seminal paper describing a device manufactured by IPAS  ( which had significant advantages over surgical abortion for early termination of pregnancy (Edwards, Jerry and Mitchell D. Creinin. 1997. Surgical abortion for gestations of less than 6 weeks. Current Problems in Obstetrics and Gynecology and Fertility, January/February: 11-19.) Edwards presented his findings at a National Abortion Federation conference.

I was at this conference, and remember my astonishment when I learned about this simple procedure. I had finished my residency training and was training in surgical abortions (D&C’s) at a Planned Parenthood clinic in NYC. I couldn’t believe how simple the procedure was, and how much potential it had to transform the provision of early abortion services. Years later, when I was finally able to access training in the procedure, I was able to perform my first Manual Vacuum Aspiration. I was surprised that the patient barely felt anything, sat up immediately after the procedure, and gave me a big hug! Since then I have been at the forefront of trying to make this procedure available to all women by developing the Early Options® model for early abortion services.

For more information, there is a reprint of an excellent paper by Carol Joffe on the history of abortion at: