What Is a LEEP Procedure?

What to Expect from Loop Electrosurgical Excision

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A loop electrosurgical excision procedure (LEEP) is used to remove (treat) abnormal cells and tissue in the cervix. It can also be done to take a biopsy sample, which can be used to diagnose cervical cancer. This procedure uses a thin wire that acts like a surgical scalpel when heated by electrical current to cut the tissue. A LEEP is typically done in the doctor's office and requires local numbing medication, not general anesthesia. Recovery is fairly quick with a low risk of complications.

Purpose

A LEEP procedure is typically done if a Pap smear or a colposcopy suggest the presence of abnormal cervical cells or cervical dysplasia. While mild cases may resolve on their own, anything more significant usually requires treatment to remove the suspect areas of tissue, as the changes could be a precursor to cervical cancer.

Cervical dysplasia is often caused by a human papillomavirus (HPV) infection. HPV is considered the main risk factor for the development of cervical cancer.

While a LEEP can remove abnormal cervical cells, it is not a cure for HPV. Even if the cells are cleared, you will still have HPV and will require ongoing monitoring to ensure that any abnormal cells are treated promptly if and when they emerge.

A LEEP may also be done so that a sample of the tissue can be tested for cervical cancer, if suspected, and an official diagnosis can be made.

There are several other procedures that can remove abnormal cells from the cervix, including cervical cryosurgery and cone biopsy. Your doctor will select one over the other based on the location of the abnormal cells in your cervix, the size and number of areas affected, and whether a biopsy is needed.

You may have a LEEP as part of a cone biopsy, in which case it would be done in the hospital operating room, rather than in the doctor's office.

Complications

The most common short-term complications of a LEEP include:

  • Heavy bleeding
  • Bacterial infection
  • Cervicitis (inflammation of the cervix)
  • Endometritis (inflammation of the uterus)
  • Pain
  • Vaginal discharge

These long-term complications are not common, but can have severe consequences:

  • Pre-term labor and delivery in subsequent pregnancies
  • Carcinogenesis (the spread of cancer cells)

If you are planning to get pregnant, tell your doctor before having a LEEP as the procedure may affect future pregnancies. A LEEP should not be performed if you are pregnant unless the indications for cervical cancer are strong.

Procedure

While a LEEP is a short procedure, it's natural to feel uneasy about it. It may help you to know what to expect, start to finish.

Before the Procedure

Your doctor will give you some instructions about what you should do before your procedure. It is generally not recommended while you are having your period because the bleeding makes it difficult to adequately visualize the tissue.

You do not need to abstain from food or drink prior to a LEEP procedure. If you take blood thinners, your doctor might ask you to stop or decrease your dose of blood thinners before the procedure.

If you are having a LEEP as part of a cone biopsy, you will need to follow instructions for the cone biopsy, which may include abstaining from food and drink and stopping some of your regular medications.

Throughout the Procedure

The LEEP procedure is usually done in your doctor's office, in a regular exam room. You should expect it to take about 20 to 30 minutes. Right before your procedure, you will be asked to undress from the waist down and put on a gown.

When it's time to begin, you will be asked to lie on the exam table with your feet in the stirrups. Your doctor will insert a speculum into your vagina and will use colposcopy to visualize the abnormal area.

A pad will then be placed on your thigh. This is an electrosurgical dispersive pad, which provides a safe return path for the electrosurgical current that will run through the wire that will be used.

Your doctor will prepare the electrosurgical generator's handpiece by placing a disposable loop electrode on its tip. Your cervix will be prepared with acetic acid and iodine solutions, such as Schiller's iodine, that enable visualization of the area, and a local anesthetic will be injected into the cervix. You may feel a burning pain from the solutions, and you may feel a pinprick sensation as the anesthetic is injected.

Your doctor may or may not use a tenaculum (surgical clamp) to help stabilize your cervix during the procedure. The electro loop wire is then passed through the surface of your cervix to remove the lesion. The electrical current sent to the wire allows it to quickly cut away the affected cervical tissue in the immediate area. The abnormal cells and tissue heat and separate as the loop wire moves through the cervix.

Pain

There is no sensation of pain or electrical shock from the wire itself, but you may experience some cramping pain as the tissue is being removed. This is variable and may depend on how much tissue is removed. For some women, the anesthetic is enough to prevent pain, and for others, the pain can be severe, even causing fainting. Your medical team will periodically ask you if you feel any pinching, pressure, burning, or cramping.

Bleeding will be stopped with a ball electrode or a topical solution, then the speculum will be removed.

Post-Procedure

You may feel a deep, dull pain after the procedure due to the wound created in the cervix. You will have some time to rest, use the restroom, and place a sanitary pad.

After you discuss any questions or concerns that you may have about your procedure or your recovery, you can leave your physician's office.

After the Procedure

After the LEEP procedure, your wound will take a few weeks to heal. Side effects can include mild pain, discomfort, bleeding, and dark discharge. Your doctor may recommend an over-the-counter medication for pain relief or may write a prescription for you.

Certain activities can cause infection or increased bleeding of the cervix as it is healing. Depending on the size and amount of tissue removed, your doctor will recommend abstaining from the following activities for a specified period of time:

  • Sexual intercourse
  • Lifting heavy objects
  • Using tampons
  • Douching
  • Taking tub baths

When to Call a Doctor

Call your doctor if you have a fever over 100.4 F or experience chills, severe abdominal or pelvic pain, heavy vaginal discharge, strong vaginal odor, or bleeding that is heavier than a normal period.

Results and Follow-Up

After a LEEP, you need to have a follow-up appointment to verify that all of the abnormal cervical tissues have been removed and to ensure that abnormal cervical cells that redevelop (if any) are caught early and treated appropriately.

If you had a biopsy, your doctor will discuss those results with you, including whether you need further treatment.

For the first year after a LEEP, your doctor may want to see you every few months for a Pap test. If your Pap tests are normal after a year, you can usually go back to annual testing.

A Word From Verywell

Cervical dysplasia may be a precursor to cervical cancer. When identified and treated early, most women do not go on to develop cancer. A LEEP is one of several options for the diagnosis and treatment of abnormal cells in the cervix.

If you have a LEEP procedure or another procedure for diagnosis or treatment of cervical dysplasia, be sure to follow up as recommended with your gynecologist or primary care doctor, so that any signs of abnormal cervical cells will be identified early. While cervical cancer often doesn't present with symptoms you can notice on your own, it's important to be aware of some that might occur as well.

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