The loop electrosurgical excision procedure (LEEP) is a gynecological treatment that cuts off a section of the cervix. LEEP is most often done to remove abnormal cervical cells that show changes that may lead to cancer. These changes are called precancerous cells. Your gynecologist will probably use the term cervical dysplasia.
LEEP uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP can:
- Cut away abnormal cervical tissue that can be seen during colposcopy.
- Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP may be done instead of a cone biopsy.
How it is done
LEEP is usually done at a hospital as an outpatient procedure (you do not have to spend a night in the hospital) or out patient surgery center.
You will need to undress from the waist down and drape a paper or cloth covering around your waist. You will then lie on your back on an exam table with your feet raised and supported by footrests (stirrups). Your medical provider will insert an instrument with curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls, allowing the inside of the vagina and the cervix to be examined.
Medicine is injected to numb the cervix (cervical block). If a cervical block is used, an oral pain medicine or pain medicine given into a vein (intravenous, or IV) may be used in addition to the local anesthetic.
Why It Is Done
LEEP is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. LEEP may be used to treat:
- Minor cell changes called low-grade squamous intraepithelial lesions (LSIL) that may be precancerous and that persist after a period of watchful waiting.
- Moderate to severe cell changes that can be removed.
How Well It Works
LEEP is a very effective treatment for abnormal cervical cell changes. During LEEP, only a small amount of normal tissue is removed at the edge of the abnormal tissue area.
After LEEP, the tissue that is removed (specimen) can be examined for cancer or precancerous cells that have grown deep into the cervical tissue. In this way, LEEP can help further diagnosis as well as treat the abnormal cells.
LEEP is as effective as cryotherapy or laser treatment. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may recur in the future. In some studies, all the abnormal cells were removed in as many as 98% of cases.1
- Infection of the cervix or uterus may develop (rare).
- Narrowing of the cervix (cervical stenosis) that can cause infertility may occur (rare).
- Incompetent Cervix which can lead to premature delivery. In subsequent pregnancies further testing will be performed to help reduce this occurrence.
What To Think About
Loop electrosurgical excision procedure (LEEP) is less expensive and easier to perform than cone biopsy or carbon dioxide laser treatment.
A biopsy is done to confirm the abnormal cervical cell changes before a LEEP procedure is done.
If you have LEEP, you need regular follow-up Pap tests. A Pap test should be repeated every 6 months or as recommended by your medical provider. After several Pap test results are normal, you and your medical provider can decide how often to schedule future Pap tests.
What To Expect After Surgery
Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. Recovery time depends on how much was done during the procedure.
- Mild cramping may occur for several hours after the procedure.
- A dark brown vaginal discharge during the first week is normal.
- Vaginal discharge or spotting may occur for about 2 weeks.
- Sanitary napkins should be used instead of tampons for about 2 weeks.
- Sexual intercourse should be avoided for about 2 weeks.
- Douching should not be done.
When to call your medical provider
Call your medical provider if you have any of the following symptoms:
- A fever greater than 100.4 degrees Fahrenheit.
- Bleeding that is heavier than a normal menstrual period
- Increasing pelvic pain
- Bad-smelling, yellowish vaginal discharge, which may point to an infection