Loop Electrosurgical Excision Procedure (LEEP)

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

The lower genital tract includes
the cervix and vagina. The cervix is the lower, narrow part of the uterus. The vagina
connects the cervix and the vulva.

With LEEP, an electric current
passes through the fine wire loop. It is then used to cut away a thin layer of abnormal
tissue. This tissue will be sent to the lab for testing. LEEP can also remove abnormal
cells to let healthy tissue grow.

LEEP may be done when cervical or
vaginal problems are found during a pelvic exam. Or it may be done if abnormal cells are
found during a Pap test. LEEP is also done to find cancer of the cervix or vagina.

Cells that appear to be abnormal,
but are not yet cancer, may be called precancer. These abnormal cells may be the first
sign that cancer could grow years later.

LEEP may also be used to help in
the diagnosis or treatment of:

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

Your healthcare provider may have
other reasons to advise LEEP.

Some possible complications may include:

  • Infection
  • Bleeding
  • Changes or scarring in the cervix from removal of tissue
  • Trouble getting pregnant
  • Preterm birth or a low birth weight
    baby

If you are allergic to or sensitive
to medicines, iodine, or latex, tell your healthcare provider.

If you are pregnant or think you could be, tell your healthcare provider.

There may be other risks depending
on your condition. Be sure to talk about your concerns with your healthcare provider
before the procedure.

Some things may cause problems with
LEEP. These include:

  • Menstruation
  • Acute pelvic inflammatory disease
  • Acute inflammation of the cervix
  • Your healthcare provider will explain
    the procedure and you can ask questions.
  • You will be asked to sign a consent
    form. This gives your permission to do the procedure. Read the form carefully. Ask
    questions if something is not clear.
  • If you are pregnant or think you may
    be, tell your healthcare provider.
  • Tell your healthcare provider if you
    are sensitive to or are allergic to any medicines, latex, tape, iodine, or
    anesthesia.
  • Tell your healthcare provider about
    all medicines (prescribed and over-the-counter) and herbal supplements that you are
    taking.
  • Tell your healthcare provider if you
    have a history of bleeding disorders. Tell him or her if you are taking any
    blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect
    blood clotting. You may be told to stop these medicines before the procedure.
  • Don’t use tampons, vaginal creams or
    medicine, or douche before the procedure. Don’t have sex before the procedure.
  • LEEP is usually done when you are not
    having your menstrual period. Tell your healthcare provider if your period has
    started.
  • Your healthcare provider may advise
    that you take a pain reliever 30 minutes before the procedure.
  • You may want to bring a sanitary pad
    to wear home after the procedure.
  • Follow any other instructions your
    provider gives you to get ready.

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

Generally, LEEP follows this process:

  1. You will be asked to undress fully or
    from the waist down and put on a hospital gown.
  2. You will be told to empty your bladder
    before the procedure.
  3. You will lie on an exam table, with your feet and legs supported as for a pelvic exam.
  4. Your healthcare provider will insert a
    tool called a speculum into your vagina to spread the walls of the vagina apart to
    show the cervix.
  5. Often, the healthcare provider will
    use a colposcope, a tool with a special lens like a microscope, to magnify the
    tissues. The colposcope will be placed at the opening of your vagina, but it does not
    enter your vagina.
  6. Your healthcare provider 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.
  7. Your cervix may be cleaned 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 have a mild burning
    feeling. An iodine solution is sometimes used to coat the cervix, called the Schiller
    test.
  8. The healthcare provider will numb the area using a small needle to inject medicine.
  9. 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.
  10. You will hear humming and/or blowing sounds from the equipment.
  11. The LEEP wire will be inserted through
    the speculum and passed through the abnormal tissues. This may take 1 or more passes.
    You may feel pressure or a slight cramping.
  12. Some women feel faint during the procedure. Tell your healthcare provider or the nurse if you have this feeling.
  13. It is very important that you lie still during the procedure.
  14. The amount and location of tissue
    removed depends on if LEEP is being used as a diagnostic tool, or to remove abnormal
    tissue. LEEP wires come in different sizes and shapes.
  15. The electrical current will 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 medicine.
  16. The tissue will be sent to a lab for
    testing.

After LEEP, 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
dark-colored discharge for several days. The dark discharge is from the medicine applied
to your cervix to control bleeding.

You may be instructed not to
douche, use tampons, or have sex for 4 weeks after LEEP, or for a period of time advised
by your healthcare provider.

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

Take a pain reliever for cramping
or soreness as directed by your healthcare provider. Aspirin or some other pain
medicines may increase the chance of bleeding. Be sure to take only approved
medicines.

Your healthcare provider will tell
you when to return for further treatment or care. Generally, women who have had LEEP
will need Pap tests more often.

Tell your healthcare provider if
you have any of these:

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

Your healthcare provider may give you other instructions after the procedure, depending on your particular situation.

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure