Loop Electrosurgical Excision Procedure (LEEP)

Overview

LEEP, which stands for loop electrosurgical excision procedure, is a method designed to both test and address abnormal cell growth on the surface tissue of the cervix, the passage connecting the vagina and uterus.

During a LEEP, an insulated wire loop is energized with electricity to safely eliminate the abnormal tissue. Following removal, the excised tissue undergoes testing to identify precancerous cells, a condition known as cervical dysplasia or cervical intraepithelial neoplasia. Although cervical dysplasia is not cancer itself, neglecting treatment can potentially progress to cervical cancer over time.

Engaging in a LEEP procedure facilitates early detection and serves as a preventative measure against the development of cervical cancer.

Reasons for undergoing the procedure

If your Pap smear or colposcopy biopsy reveals abnormal cervical cells, your doctor might suggest undergoing a LEEP procedure. Colposcopy, a noninvasive technique resembling a microscopic examination, is employed to magnify the cervix, enhancing the visibility of abnormal growth.

LEEP is utilized for both the diagnosis and treatment of cervical dysplasia, as well as addressing conditions such as genital warts and polyps.

Risks

Complications are uncommon, and the procedure is typically performed without the need for general anesthesia. Similar to any surgical intervention, there is a minimal risk of infection or bleeding.

In cases where a substantial area requires removal or if multiple LEEP procedures are necessary, your doctor may monitor your cervix using ultrasound in subsequent pregnancies. It’s important to note that LEEP may potentially weaken the cervix, potentially resulting in the early delivery of a baby (preterm birth).

Engage in a discussion with your doctor to address any concerns you may have, including potential long-term side effects.

Before the procedure

Before undergoing the LEEP procedure, your doctor will assess your medical history to ensure there are no conditions that might pose a risk. Conditions such as acute pelvic inflammatory disease (PID) or cervicitis (inflammation of the cervix) may be contraindications for LEEP.

Before undergoing a LEEP procedure, you might need to take a pregnancy test and your doctor will guide you on the appropriate timing for the procedure if you’re pregnant.

Assuming there are no contraindications, your doctor will schedule the LEEP at a time when you are not menstruating, preferably about a week after your period concludes.

To prepare for the procedure, follow your provider’s instructions, which may include:

• Refraining from intercourse, using vaginal creams, or douching 24 hours before the procedure.
• Bringing a pad to manage any post-procedural vaginal discharge.
• Ceasing the use of medications that impact blood clotting, such as anticoagulants or aspirin.
• Taking a pain reliever like ibuprofen or acetaminophen 30 minutes prior to the procedure.
• On the day of the procedure, it’s advisable to wear comfortable, easily removable clothing that can be swapped out for a hospital gown.

During the procedure

A LEEP procedure can be conducted either in your gynecologist’s office, a hospital, or an outpatient setting.

Preparation for the procedure: The LEEP procedure commences similarly to a routine pelvic exam. Although you will remain awake during the process, any discomfort should be minimal. Initially, you will be asked to recline and position your feet in stirrups at the end of the examination table. A grounding pad will be placed on your thigh to protect against the electricity used during LEEP. To obtain a clearer view of your cervix, your provider will employ a speculum to widen your vagina.

A diluted solution of acetic acid or Lugol’s solution (Iodine) will be applied to your cervix to enhance the visibility of abnormal cells. Subsequently, a colposcope will be positioned near the opening of your vagina, offering a magnified perspective of your cervix.

Numbing the cervix: Your cervix will be numbed with local anesthesia (lidocaine). During the injection, you might feel tingling in your tongue, ringing in your ears, or a brief increase in heart rate, which usually lasts only a few minutes. After your cervix is numb, your provider will insert an electrically charged loop, made of thin wire, through the speculum until it reaches your cervix.

Abnormal tissue excision: Maintaining stillness is crucial during the tissue removal phase. As the loop traverses your cervix, it removes a thin layer of surface tissue, eliminating abnormal cells. In some cases, a second loop may be used to reach higher in your cervix. The excised tissue will undergo later testing for signs of cancer or abnormal cells.

Control the bleeding: To conclude the procedure, your doctor will apply a medicated paste (Monsel’s paste, an iron solution) to the area to halt and prevent bleeding.

The entire procedure typically lasts between 10 to 20 minutes. Once you feel ready, you can go home immediately afterward.

After the procedure

Following the procedure, you may experience lightheadedness and might need to take some time to rest in your doctor’s office until you feel comfortable enough to drive home. Typically, this resting period is completed in less than 30 minutes. Your doctor will provide you with aftercare instructions to assist in your recovery.

Outcome

What to anticipate during the recovery at home following a LEEP:

After the procedure, you may experience fatigue, and it’s crucial to prioritize rest on the day of your LEEP. Adhere to your doctor’s guidance for self-care in the ensuing days and weeks.

Recovery may involve:

• Cramping: Expect mild cramping for a few days post-procedure, which can be managed with over-the-counter pain medications.
• Vaginal drainage or spotting: Anticipate greenish-yellow discharge immediately after the procedure, accompanied by a mildly unpleasant smell. A brownish-black vaginal discharge is also normal for one to three weeks. Manage this discharge with pads.
• Menstrual cycle: Your regular menstrual cycle should not be disrupted by the procedure.
• Exercise and activity restrictions: Avoid excessive activity for the first 48 hours and restrict exercise for at least one week post-LEEP. Monitor any post-exercise bleeding unrelated to menstruation and cease activity if necessary, allowing your body sufficient time to heal.
• Intercourse restrictions: Refrain from intercourse for at least four weeks while your cervix heals. Avoid activities such as douching or inserting tampons and other items into your vagina during this period.
• Bathing restrictions: While regular showering is permitted, refrain from taking baths until your provider confirms it is safe to do so.