LEEP (Loop Electrosurgical Excision Procedure) is performed to further evaluate abnormal cervical cells. Excision provides a sample of tissue to confirm the degree of abnormality and check for cancerous or precancerous cells deep within the cervix. For some women, excision can also remove the abnormal cells completely. If the edges of the tissue that is removed show evidence of the abnormality or precancer, further treatment may be needed. This procedure utilizes a very thin wire in the shape of a loop and modern electrosurgical generators that allow accurate and selective blending of an electric current. The loop is carefully passed from one side of the cervix to the other, allowing the cutting current to divide the tissue. The removed portion of the cervix will be sent to a pathology lab for microscopic evaluation. Typically, a woman is seen for a follow up examination several weeks after treatment to make sure the cervix is healing.
Your provider has recommended LEEP because of abnormal cells on your cervix that could develop into pre-cancerous or cancerous lesions. The LEEP will help determine the extent of the abnormality and whether or not you need further treatment. It is also possible that a LEEP will remove all abnormal cells on your cervix and you will need only regular pap tests in the future.
Before your LEEP appointment, you should not put anything in the vagina and abstain from intercourse for 48 hours. LEEP can be done at any time during your menstrual cycle, but if you have heavy vaginal bleeding on the day of your appointment call to ask if you should reschedule.
Excision can be done in the clinician’s office or operating room after the cervix is injected with local anesthesia to prevent pain. Your provider will insert a speculum to visualize your cervix and clean it with betadine. You may feel a dull ache or cramp during the procedure. A brown paste is applied after the treatment to prevent bleeding; this often causes a dark vaginal discharge (similar to coffee grounds). Most women are able to return to work or school after the procedure. Following a cervical excision, most women have mild to moderate vaginal bleeding and discharge for one to two weeks. The bleeding should not be heavy (eg, should not soak a pad in less than one hour).
Although LEEP is effective, recurrence or persistence of cervical dysplasia is possible. Women that are not cured after LEEP may have persistence, recurrence, or progression of the abnormality, especially if a high-risk type of human papillomavirus (HPV) is present. For this reason, lifelong follow up with cervical cytology smears (Pap test) is important. The type of follow-up and time interval between subsequent tests will depend upon the results of the initial testing and your age. The decision to have additional treatment is individualized, based upon the type of abnormality seen, your risk of cervical cancer, and whether or not childbearing is completed.