The Loop Electrosurgical Excision Procedure, often called LEEP, is a treatment to remove abnormal cells from the cervix. This procedure is a common approach when screenings reveal cellular changes, often caused by the human papillomavirus (HPV), that could develop into cancer. The primary purpose of LEEP is to remove this affected tissue, preventing its potential progression to cervical cancer while allowing for laboratory analysis.
The Medical Basis for a LEEP Procedure
The recommendation for a LEEP procedure originates from the detection of abnormal cellular changes on the cervix, a condition known as cervical dysplasia. These changes are most frequently caused by persistent infection with high-risk types of human papillomavirus (HPV). While many HPV infections resolve on their own, some lead to alterations in cervical tissue identified during routine screenings. These abnormalities are a precursor to cancer but are not yet cancerous.
To categorize these cellular changes, clinicians use the Cervical Intraepithelial Neoplasia (CIN) system, graded on a scale from 1 to 3. CIN 1 indicates mild changes that often clear up without intervention. CIN 2 signifies moderate abnormalities, and CIN 3 denotes severe changes that have a higher likelihood of progressing to cancer if untreated.
A LEEP is advised for moderate to severe dysplasia (CIN 2 or CIN 3). This intervention follows a colposcopy and biopsy, which confirm the grade of the abnormal cells. The procedure acts as both a treatment and a diagnostic tool, as the removed tissue is examined to confirm the diagnosis.
The LEEP Procedure Explained
Patients are advised to schedule the procedure for a time when they are not on their menstrual period to ensure the best visibility of the cervix. It is also recommended to abstain from sexual intercourse, douching, or using tampons for at least 24 hours before the appointment.
The LEEP procedure is performed in a doctor’s office and takes about 10 to 20 minutes. The patient lies on an examination table in the same position as for a Pap smear, with feet in stirrups. A provider inserts a speculum into the vagina to view the cervix, and a colposcope may be used for magnification. A solution of acetic acid is applied to the cervix to make the abnormal cells visible.
Following this, a local anesthetic is injected into the cervix to numb the area. Patients might feel a small pinch from the injection and some report a temporary feeling of a racing heart, a normal side effect of the anesthetic. Once the cervix is numb, the provider uses a thin wire loop energized by a low-voltage electrical current to excise the abnormal tissue.
During the excision, patients may feel a sense of pressure or mild cramping and might hear a quiet sound from the electrosurgical unit. The electrical current simultaneously cauterizes the blood vessels, which helps to minimize bleeding.
Immediately after the tissue is removed, the provider may apply a medicated paste to the area to further prevent bleeding. After the speculum is removed, the patient will rest for a short period before being cleared to go home.
Post-Procedure Recovery and Care
It is common for patients to have mild cramping, similar to menstrual cramps, for a day or two, which can be managed with over-the-counter pain relievers. A watery, pinkish discharge is also typical for the first few days as the cervix heals.
A distinct aspect of recovery is a dark brown or blackish vaginal discharge that may have a coffee-ground-like consistency. This is the result of the medicated paste applied to the cervix to control bleeding, and it will be expelled from the body over several days to a few weeks.
To support proper healing and prevent infection, several activities should be avoided for approximately three to four weeks:
- Using tampons or douches
- Engaging in sexual intercourse
- Heavy lifting and strenuous exercise for at least the first week
- Baths and swimming, though showers are permissible
While most recovery is mild, contact a healthcare provider for specific warning signs:
- Heavy bleeding that soaks through more than one pad per hour
- Passing large blood clots or bleeding heavier than a normal period
- Severe abdominal pain not relieved by pain medication
- A fever or foul-smelling vaginal discharge
Interpreting Results and Subsequent Monitoring
The cervical tissue removed during the LEEP procedure is sent to a laboratory for analysis. This examination determines the nature of the abnormal cells and whether the entire lesion was removed. The pathology report will indicate the status of the margins, which are the edges of the excised tissue. “Clear” or “negative” margins mean that no abnormal cells were found at the edges, suggesting all affected tissue was successfully removed.
Conversely, “positive” margins indicate that abnormal cells were present at the edge of the tissue sample. This suggests that some abnormal cells may remain on the cervix. In such cases, the healthcare provider will discuss the need for further treatment or more intensive follow-up. Even with positive margins, the body’s immune response can sometimes clear the remaining cells, so re-treatment is not always necessary.
LEEP is a highly effective treatment, with a high success rate in removing all abnormal cells in a single session. A follow-up plan is established to monitor the cervix for recurrence, starting with an appointment about six months after the LEEP. Subsequent monitoring will include more frequent HPV tests or Pap smears than the standard screening interval and continues for several years.
Potential Risks and Future Health Considerations
While LEEP is a safe procedure, there are potential risks and long-term considerations. Though uncommon, there is a slight increase in the risk of certain complications in future pregnancies, such as preterm birth or a baby with a low birth weight. The removal of cervical tissue can, in some cases, slightly weaken the cervix or reduce its length.
Another infrequent risk is cervical stenosis, a narrowing of the cervical opening due to scarring. This condition can sometimes interfere with menstruation or conception but is treatable. In very rare instances, the procedure can lead to an incompetent cervix, where the cervix begins to dilate too early during pregnancy. The majority of women who have a LEEP procedure experience no negative impact on their future fertility or pregnancies.
Other procedural risks, while rare, include infection and significant bleeding that requires further medical intervention. Patients are advised to inform their healthcare provider of any health conditions and plans for future pregnancies to help with long-term care planning.