LEEP is Loop Electrosurgical Excision Procedure. It is a procedure used to remove abnormal cells from your cervix. This is usually indicated when you have cervical dysplasia characterized as high grade (moderate or severe dysplasia). Please read the following frequently asked questions to prepare for your procedure.
What can I expect to happen during the procedure? After your cervix is made numb, a thin wire loop with electric current passing through it is used to remove abnormal cells. The loop excision part of the procedure is very quick, in most cases a few seconds. Then the cervix is cauterized to take care of any bleeding. The entire procedure takes only a few minutes to complete.
Will it hurt? A local anesthetic will be used, so you will not have pain during the procedure. The anesthetic is lidocaine, and it will be injected into the cervix with a skinny needle. You may feel a very brief, sharp cramp at the beginning of the injection, but then your cervix is quickly numbed; so you won't feel any pain. The cervix has different kind of pain nerves than most other tissues in your body, so you perceive a kind of crampy pain rather than sharp pain. The external genitals and vagina are very sensitive to touch and pain compared to the cervix. This is why injection of the cervix does not hurt the way you might expect if your more sensitive tissues were injected. Some women experience mild cramping. Most tolerate it very well. Rest assured, if this were a very painful procedure, we would not perform it in the office!
Can I bring a support person to be with me during the procedure? While it's a good idea to bring someone who can drive you home (some patients get a little light-headed), we cannot allow anyone to accompany you in the room during the procedure. Sometimes support persons become light-headed (or even pass out) with the sight of blood or just seeing their loved-one having a "surgical" procedure. We need to be able to devote all of our attention to you, the patient.
What can I expect afterwards?Pain? You may have some cramping, like during a period, but not severe. Ibuprofen is good for this. Bleeding? You may have light to moderate bleeding (like a period) for a few days, maybe up to two weeks. Restrictions? You should refrain from heavy exertion for 2-3 weeks. It could increase bleeding. Also, no sex or tampon use for 3 weeks.
How do I know if the procedure removed all of the abnormal cells? All tissue removed from the cervix will be sent to pathology for microscopic examination. They will tell us if the surgical margins contain any abnormal cells. If the margins are negative, it is very unlikely that any abnormal cells remain on the cervix. Follow-up Pap tests will detect any abnormal cells after healing. There is a 5-10% recurrence rate for dysplasia.
What is the follow-up? Pap testing will be recommended more frequently for at least 2 years. Initially, Paps will be every 4 months, then every 6 months. After several normal follow-up Paps, you'll be told it's okay to return to yearly Pap testing. You may have one or more abnormal Paps in the follow-up period. This will not necessarily mean you need another treatment, but it will prolong the follow-up period in some cases.
