Healing is a matter of time, but it is sometimes also a matter of opportunity.
Hippocrates
LEEP: Loop Electrosurgical Excision Procedure
If your gyn visit revealed an abnormal pap, and following that, your coloposcopy-directed cervical biopsies confirm an abnormal Pap smear to be high-grade dysplasia, it needs to be treated. High-grade dysplasia (as opposed to low-grade dysplasia) is a precursor to cervical cancer, and should be removed to prevent cancer from developing.
We will most often recommend a LEEP in this setting. “LEEP" is an abbreviation for loop electrosurgical excision procedure. It is a way to test and treat abnormal cell growth on the surface of the cervix.
How LEEP Is Performed
LEEP is currently the most often performed procedure used to remove abnormal cells from the cervix. Other procedures are cryosurgery, laser treatment, and surgical cone biopsy. The decision of which method to use depends on how much cervical tissue needs to be removed and where on the cervix the abnormal cells are located. Because of the ability to safely remove only abnormal cells, while leaving much of the cervix intact, LEEP has grown in popularity and is generally our treatment of choice .
LEEP uses a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a small portion of the central exterior cervix. The procedure should be done when you are not having your menstrual period to allow a better view of the cervix. In most cases, LEEP can be done in our office. The procedure only takes a few minutes, and is not painful when numbing medicine is used. If you are anxious, or feel you have a low pain threshold, it is also reasonable to do the LEEP in the operating room, with some IV sedation and some pain medication.
As with the pap smear and colposcopy, for the LEEP, you will be asked to lie on your back with your legs in stirrups (“dorsal lithotomy” position.) We will will place a warmed, specially-coated speculum into your vagina to view the entire cervix. Local anesthesia will be used in an intracervical block. It is given through a long needle attached to a syringe. You may feel a slight sting, then a dull ache or cramp.
The loop is connected to a machine that allows heat conduction through the wire at the end. With this tool we can cut and coagulate (stop bleeding). While there are different sizes of loops that can be used, we will typically use a small loop for focused disease, a wider loop to remove a broader lesion. You may feel faint during the procedure, or note your heart racing, or metallic taste in your mouth. If so, please let us know.
After the procedure, a special paste (liquid bandage: ferrous subsulfate or "Monsel's solution) may be applied to your cervix to stop any bleeding.
The tissue that is removed will be sent to pathology in order to confirm the diagnosis. As with the cervical biopsies, the results are typically back to us in 10-14 days.
Risks of LEEP
No procedure is without it's risks; everything we do in medicine involves carefully weighing the risks and benefits. By not treating high-grade dysplasia, we are risking development of cervical cancer over time, in many cases. However, 1 in 100 LEEP procedures will be associated with heavy bleeding, usually in the first few days, but it can be as late as up to the first 3 weeks after a LEEP. If you have experience this, please contact our office, for an exam that same day. You may need to have more of the paste applied or other measures done to control the bleeding.
We are very aware that many of our patients who require LEEP will want to have children in the future. LEEP, especially multiple procedures, has been associated with an increased risk of future pregnancy problems, typically preterm delivery at 34-36 weeks gestation. In order to minimize this possibility we will consciously tailor the removal of abnormal cells to minimize damage to the integrity of your cervix. Your Recovery
After the procedure, you will notice:
- a watery, pinkish discharge
- mild cramping
- a brownish-black discharge (from the paste used)
It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have intercourse for 3-4 weeks.
Please contact us if you have any of the following problems:
- Heavy bleeding (more than your normal period)
- Bleeding with clots
- Severe abdominal pain
- Fever
- Foul-smelling vaginal discharge
The Future
After the procedure, you will need to see us for often for Paps this year. Generally, we will do a Pap test every 6 months until you have 3 normal results. If you have another abnormal Pap test result, you may need further evaluation.
Protect Yourself from Future Cervical Disease:
- Annual Paps: For the rest of your life, a patient with high-grade dysplasia should have annual Pap tests. Don’t let the insurance company talk you out of it. 20 years from now, you are still at risk of recurrent cervical disease.
- Quit smoking: for every possible reason, but especially because smoking increases your risk of cancer of the cervix.
- Partner Selection: perhaps the most important risk factor for cervical disease. Choose sexual partners carefully: those with fewer past partners construe lower risk to you.
- Limit your lifetime number of sexual partners.
- Use Condoms. Never have sex without a condom to reduce your risk of being exposed to more of the 40 or so pre-cancerous strains of HPV, as well as co-incident STDs which may increase persistence of HPV.
"Rise to the occasion which is life!" ~ Virginia Euwer Wolff
