Loop Electrosurgical Excision Procedure (LEEP)

What is a LEEP (loop electrosurgical excision procedure)?

LEEP (loop electrosurgical excision procedure) removes abnormal tissue on the surface of your cervix. Then, the tissue is tested for precancerous cells, a condition called cervical dysplasia. Cervical dysplasia isn’t cancer, but it can lead to cervical cancer over time without treatment.

Your healthcare provider may recommend LEEP after a Pap smear or colposcopy confirms that you have abnormal cells on your cervix. LEEP is also a diagnostic and treatment tool for cervical polyps and genital warts.

How should I prepare for a LEEP?

Your healthcare provider will ensure you don’t have any conditions that may prevent you from getting the procedure. For instance, you shouldn’t have a LEEP if you:

• Have acute pelvic inflammatory disease (PID)
• Have inflammation of your cervix (cervicitis)

You may need to take a pregnancy test before getting a LEEP. Your provider can recommend the right timing for a LEEP if you’re pregnant. They’ll schedule the procedure at a time when you’re not on your period.

Follow your provider’s instructions about how to prepare. Your provider may tell you to:

• Avoid having intercourse or using vaginal creams for 24 hours before the procedure
• Pack a pad that you can wear after the procedure to catch any vaginal discharge
• Stop taking medications that affect how your blood clots, like anticoagulants or aspirin
• Take a pain reliever like ibuprofen (Advil® or Motrin®) or acetaminophen (Panadol® or Tylenol®) 30 minutes before the procedure
• Wear loose-fitting clothes that you can easily remove and replace with a hospital gown on the day of your procedure

What happens during a LEEP procedure?

A LEEP can occur in your gynecologist’s office, in a hospital or an outpatient setting.

Preparing for the procedure

LEEP begins much like a regular pelvic exam. Though, you’ll remain awake throughout the procedure, you should feel only minor discomfort. First, your provider will ask you to lie back and rest your feet in stirrups at the end of the exam table. A grounding pad will be placed on your thigh to protect you from the electricity used during the LEEP. Your provider will widen your vagina with a speculum to get a clearer view of your cervix.

Then, your provider adds a very dilute solution of acetic acid or Lugol’s solution (iodine) to your cervix to make the abnormal cells visible. They’ll then place a colposcope near the opening of your vagina. This tool gives your provider a magnified view of your cervix, but stays outside of your body.

Numbing your cervix

Your provider will use local anesthesia (lidocaine with epinephrine) to numb your cervix. The numbing shot causes a brief, sharp pinch, and then a quick burning feeling, like when you get numbed for dental work.

You may also feel a racing heartbeat or dizziness from the epinephrine. If this occurs, it lasts for only a few minutes.

After your cervix is numb, your provider places a wire loop with electricity on it.

Removing the abnormal tissue

You must remain still during the tissue removal process. As the wire loop passes across your cervix, it cuts away a thin layer of surface tissue, removing abnormal cells. Sometimes, your provider will use a second loop to reach a little higher in your cervix. This tissue will be tested later for cancer or abnormal cells.

You may feel a warming sensation and/or a light vibration during this part of the procedure.

Stopping the bleeding

Finally, your provider will apply a medicated paste (an iron solution called Monsel’s paste) to the area to stop and prevent bleeding.

How long does it take?

The procedure takes 10 to 20 minutes. You’ll be able to go home as soon as you feel up to it.

What are the benefits and risks of LEEP?

LEEP is very safe. Complications are rare, and the procedure can take place without general anesthesia. As with any surgery, you may be at risk of infection or bleeding. LEEP may weaken your cervix, leading to preterm birth in future pregnancies. Discuss any concerns you may have with your provider before the procedure.

The benefits outweigh the risks, though. LEEP is one of the most effective ways to remove precancerous cells from your cervix, which reduces the risk of cancer developing. It also has a high success rate in removing abnormal cells.

How painful is the LEEP procedure?

It depends on your pain tolerance. Healthcare providers use a local anesthetic to numb your cervix, so you don’t feel pain. But you may feel a sharp pinch or a sting when they numb your cervix. You may also feel pressure and/or warmth when your provider removes the tissue.

Let your provider know if you start to feel intense pain at any point during LEEP.

What happens after LEEP?

You may need to rest in your provider’s office until you’re comfortable enough to drive home. This initial recovery usually takes between 30 and 60 minutes. Your provider will use this time to go over aftercare instructions with you. Ask them any questions you have about your recovery.

What can I expect when recovering?

It’s important to get plenty of rest on the day of your LEEP. Follow your provider’s instructions on how to care for yourself in the days and weeks ahead.

During recovery, you can expect:

• Cramping for a few days: Mild cramps are common after LEEP. You may need to take over-the-counter pain medications for a few days to manage the discomfort.
• Vaginal drainage or spotting for one to three weeks: You’ll have greenish-yellow vaginal discharge immediately after. It may have an unpleasant smell. A brownish-black discharge is also normal. You can wear pads (not tampons) to manage the discharge.
• Aching and discomfort: You may feel aches and pains in your abdomen or inside your vagina. It may feel like a scraped knee, but on your cervix. This should only last a short time.
• A regular menstrual cycle: The procedure shouldn’t disrupt when you get your next period or how much you bleed.

You can expect the following restrictions after LEEP:

• Avoiding exercise and activity: Avoid excessive activity for 48 hours after the procedure and restrict exercise for at least one week after a LEEP. Note any bleeding that occurs once you start exercising. If it’s unrelated to menstruation, stop exercising and allow your body more time to heal before getting active.
• Restrictions on sexual intercourse: Wait to have intercourse for at least four weeks while your cervix heals. Avoid inserting tampons, sex toys, etc., into your vagina, too.
• Bathing restrictions: You can shower normally, but avoid taking baths (or swimming) until your provider tells you it’s safe.

How do I relieve pain and discomfort?

During your recovery, you may experience vaginal bleeding and mild cramping. Take a non-aspirin pain reliever such as ibuprofen or acetaminophen for pain relief.

How long does it take to recover?

It takes four to six weeks for your cervix to fully heal after LEEP. You can return to work or school one to two days after your procedure.

Does the cervix grow back after the procedure?

Yes. New, healthy tissue grows on your cervix to replace the tissue your provider removed.

What happens after I get my LEEP results?

LEEP is both a diagnostic tool and a form of treatment. Removing the tissue for testing often cures cervical dysplasia by eliminating the abnormal cells.

In some instances, you may need a repeat procedure to completely remove the cells. You may also need an additional LEEP if abnormal cells return. You’re at a greater risk of recurrence if you’re infected with a high-risk strain of human papillomavirus (HPV). HPV is responsible for the cell changes that can lead to cervical cancer without treatment.

If HPV persists, you may need frequent Pap and HPV tests to check for infection and ensure no new abnormal cell changes become cervical cancer.

Do I still have HPV?

It’s possible to have HPV after LEEP. LEEP removes the abnormal cells that form in response to HPV infection, but it can’t eliminate the virus itself.

When should I contact my healthcare provider?

Contact your healthcare provider if you notice signs of an infection or any of the following symptoms during recovery:

• Heavy bleeding (more than a normal menstrual flow)
• Bleeding with clots
• Vaginal discharge that has an increasingly foul odor
• Fever
• Severe abdominal pain