Loop Electrosurgical Excision Procedure (LEEP)

LEEP stands for Loop Electrical Excision Procedure. A LEEP procedure may be recommended as a treatment for abnormal cervical tissue or dysplasia. Dysplasia is the word used to describe precancerous cell changes found on the cervix and is characterized by degree of severity - mild, moderate or severe. The Human Papillomavirus (HPV) is believed to be the primary cause of most abnormal cervical tissue. LEEP is most commonly recommended as a treatment for moderate to severe dysplasia, although in certain situations it may also be used to treat mild dysplasia.

What should be expected during a LEEP?

The LEEP procedure utilizes an electrical current that passes through a thin wire loop, which is used to "scoop out" the abnormal tissue. Since the wire is very thin, there is very little damage to the surrounding tissue. The electrical current seals the blood vessels, which minimizes bleeding. The procedure is done in the doctor's office and does not require any sedating anesthesia. The procedure itself takes about 20 minutes. After a speculum is inserted into the vagina, the doctor will look at the cervix with the colposcope (a magnifying instrument) to clearly identify the area that is to be removed. A local anesthetic will be injected into the cervical tissue prior to the removal of any tissue. During the procedure there may be discomfort similar to menstrual cramps. Ibuprofen may be used to minimize cramping. A medicated paste may be applied after the tissue is removed to lessen bleeding. Usually no pain medication is required afterward. Since no sedation is required, you may be able to return to work or classes later the same day.

Are there treatment alternatives?

Abnormal pap smears can be treated in several ways. The physician may recommend LEEP, cryotherapy (freezing the cervical tissue) or use of a laser beam, depending on examination findings and the degree of dysplasia identified in tissue biopsies. In some cases, treatment may be deferred and close follow-up with colposcopic exams and pap smears recommended. You are encouraged to discuss all the treatment options and understand why your provider recommends a particular course of treatment.

Most cervical abnormalities can be treated with LEEP. Laser surgery may be recommended, especially if there is abnormal tissue identified on the external genital or internal vaginal tissue as well as the cervix. LEEP and laser procedures are not available at McKinley, but referrals will be provided to specialists who can perform the procedure. Cost for any procedure not done at McKinley Health Center is the responsibility of the patient, but may be partially covered by health insurance. Before scheduling a procedure, always consult with your health insurance carrier to determine what is covered by the policy.

What are the risks?

Pre-LEEP Instructions

Post-LEEP Instructions

What should my partner do?

Currently there is no consensus among medical professionals regarding the correct way to diagnose and treat male partners of women who have abnormal pap smears. HPV is not easy to detect and may be present for years before it causes abnormal pap smears. Since the virus can be sexually transmitted, women may request that their partner be examined for sexually transmitted diseases, including HPV. These exams may be done at McKinley Health Center if the partner is a student, or at a local public health clinic, or by a private physician.

Reference

Up to Date 2009.