The LEEP Procedure, or Loop Electrosurgical Excision Procedure, is a safe and effective procedure by which a portion of the cervix containing abnormal cells is removed. LEEP may be done to either treat a precancerous condition known as severe cervical dysplasia discovered on colposcopic exam/biopsy or to confirm the suspicion of a microscopic cervical cancer on a PAP test.
Less commonly, LEEP can be used to remove multiple genital warts from the vulva or excise vulvar dysplasia.
A LEEP usually takes about 20 minutes and is easily done in the office setting. To perform a LEEP, a wire loop heated by an electrical current and attached to a hand-held probe is used to excise the abnormal tissue from the surface of the cervix. The wire loop acts like a scalpel (surgical knife). It allows a thin layer of the cervix to be removed. Various shapes and sizes of the wire loop are used, depending on the size and orientation of the abnormal tissue.
To start, a local anesthetic is injected directly into the cervix. Under colposcopic guidance, the loop is passed through the surface of the cervix to remove the abnormal area. If needed, a second pass is done to remove abnormal tissue higher up, from the canal of the cervix.
After the procedure, a special paste may be applied to the cervix to stop any bleeding. The cervical tissue that is excised is sent to a pathology lab for microscopic evaluation.
The LEEP procedure should be performed mid-cycle so as to have a better view of the cervix in the absence of blood and to not confuse menstrual bleeding with bleeding post-LEEP.
Following a LEEP, there is usually some pelvic cramping and a watery, pinkish or brownish-black (from the past used) vaginal discharge. Sometimes there is mild vaginal bleeding. If heavy vaginal bleeding (especially with clots) or worsening abdominal/pelvic pain should occur, the office must be contacted.
Like any procedure, LEEP carries some risks. Other than the risk of heavy vaginal bleeding, the risks of LEEP include:
- Infection (suspected with any foul-smelling vaginal discharge)
- Scarring or anatomical changes in the cervix
- Difficulty getting pregnant (small risk)
- Potential for pregnancy loss or preterm birth (small risk)
The recovery time is brief for most women. Normal activities like returning to work can be resumed in one-to two days. The cervix itself typically takes 4 weeks to heal.
After the procedure, a follow-up visit is set up for two weeks to examine the cervical healing process and review pathology results. Also, the plan for further cervical surveillance with PAP and HPV testing is established and discussed. There is the possibility that there may be a need for another LEEP if the margins, or edges, of the removed specimen have dysplasia or if in the future another abnormal PAP test occurs. However, there is also the possibility that treatment will never be needed again. Importantly, women with severe cervical dysplasia treated with LEEP or any other method need to be followed regularly for 25 years to make sure it doesn’t return.
- Adhering to the cervical surveillance plan established by the gynecologist
- Stopping smoking because smoking increases the risk for cervical cancer
- Limiting the number of sex partners and using condoms to reduce the risk of sexually transmitted infections (STIs)
At Adaptive Gynecology, we are experienced in managing cervical and vulvar dysplasia with the use of LEEP to prevent cervical and vulvar cancer.
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