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LEEP (Loop Electrosurgical Excision Procedure)

What is LEEP?

Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment for abnormal or cancerous conditions in a woman’s lower genital tract.

With LEEP, an electric current passes through the fine wire loop to cut away a thin layer of abnormal tissue. This tissue is sent to the lab for examination. LEEP can also remove abnormal cells to allow healthy tissue to grow.

When is LEEP performed?

LEEP may be performed when cervical or vaginal problems are found during a pelvic examination, or abnormal cells are found during a Pap test. LEEP is also performed to detect cancer of the cervix or vagina.

Cells that appear to be abnormal, but are not cancerous at the present time, may be identified as precancerous. The appearance of these abnormal cells may be the first evidence of cancer that could develop years later.

LEEP may also be used to assist in the diagnosis or treatment of the following conditions:

  • Polyps (benign growths)
  • Genital warts, which may indicate infection with human papilloma virus (HPV), a risk factor for developing cervical cancer
  • Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy, as DES exposure increases the risk for cancer of the reproductive system

There may be other reasons for your physician to recommend LEEP.

What should I expect from the procedure?

LEEP may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, LEEP follows this process:

  • You will be asked to undress completely or from the waist down and put on a hospital gown.
  • You will be instructed to empty your bladder prior to the procedure.
  • You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
  • Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
  • Often, the physician will use a colposcope, an instrument with a special lens similar to a microscope, to magnify the tissues. The colposcope will be placed at the opening of your vagina but does not enter your vagina.
  • Your physician will look through the colposcope to locate any areas for treatment on the cervix or in the vagina. Photographs with the colposcope or sketches of the areas on your cervix may be made for your healthcare record.
  • Your cervix may be cleansed and soaked with a vinegar solution, also called acetic acid solution. This helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution is sometimes used to coat the cervix, called the Schiller test.
  • The physician will numb the area using a small needle to inject medication.
  • A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure. You may feel some cramping when the tenaculum is applied.
  • You will hear humming and/or blowing sounds from the equipment.
  • The LEEP wire will be inserted through the speculum and passed through the abnormal tissues. One or more passes may be needed. You may feel pressure or a slight cramping.
  • Some women feel faint during the procedure. Tell your physician or the nurse if you have this feeling.
  • It is very important that you lie still during the procedure.
  • The amount and location of tissue removed depends on the whether LEEP is being used as a diagnostic tool, or to remove abnormal tissue. LEEP wires come in different sizes and shapes.
  • The electrical current will act as a cautery to seal the blood vessels, so usually there is very little bleeding. Any bleeding from the LEEP site may be treated with a paste-like topical medication.
  • The tissue will be sent to a lab for further examination.

What happens after the procedure?

You may rest for a few minutes after the procedure before going home. You may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.

You may be instructed not to douche, use tampons, or have intercourse for four weeks after LEEP, or for a period of time recommended by your physician.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

Take a pain reliever for cramping or soreness as directed by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Your physician will advise you on when to return for further treatment or care. Generally, women who have had LEEP will need more frequent Pap tests.

Notify your physician if you have any of the following:

  • Bleeding with clots
  • Foul-smelling drainage from your vagina
  • Fever and/or chills
  • Severe abdominal pain

Are there any risks associated with LEEP?

As with any surgical procedure, complications may occur. Some possible complications may include, but are not limited to, the following:

  • Infection
  • Bleeding
  • Changes or scarring in the cervix from removal of tissue
  • Difficulty getting pregnant
  • Potential for preterm birth or having a low birth weight baby

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.