What is a loop electrosurgical excision procedure (LEEP)?
Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue in a woman’s lower genital tract. It is used as part of the diagnosis and treatment of abnormal or cancerous conditions.
The lower genital tract includes the cervix and vagina. The cervix is the lower, narrow part of the uterus and the vagina connects the cervix and the vulva.
With LEEP, an electric current passes through the fine wire loop 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 allow healthy tissue to grow.
Why will anyone need a LEEP?
LEEP may be done when cervical or vaginal problems are found during a pelvic exam, or abnormal cells are found during a Pap test. LEEP is also done to detect cancer of the cervix or vagina.
Cells that appear to be abnormal, but are not yet cancerous, may be called precancerous. These abnormal cells may be the first evidence of cancer that could develop years later.
LEEP may also be used to assist in the diagnosis or treatment of the following conditions:
What are the risks for a LEEP?
Some possible complications may include:
- Changes or scarring in the cervix from removal of tissue
- Trouble getting pregnant
- The potential for preterm birth or having a low weight baby
If the patient is allergic or sensitive to medications, iodine, or latex, inform the healthcare provider.
If the patient is pregnant or thinks she could be, tell the healthcare provider.
There may be other risks depending on the patient’s condition. Be sure to discuss any concerns with healthcare provider before the procedure.
Certain factors or conditions may interfere with LEEP. These factors include:
How does the patient get ready for LEEP?
- The healthcare provider will explain the procedure and the patient can ask questions.
- Generally, no preparation, such as fasting or sedation, is needed.
- Tell the healthcare provider if the patient is sensitive to or are allergic to any medicines, latex, tape, iodine, and anesthesia.
- Tell the healthcare provider about all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
- Tell the healthcare provider if the patient has a history of bleeding disorders or if she is taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. The patient may be told to stop these medicines before the procedure.
- The healthcare provider will tell the patient not to use tampons, vaginal creams or medicine, douching, or having sex before the procedure.
- LEEP is usually done when the patient is not having her menstrual period.
- The healthcare provider may recommend that she takes a pain reliever 30 minutes before the procedure.
- The patient may want to bring a sanitary napkin to wear after the procedure.
Follow any other instructions your provider gives you to get ready.
What happens during a LEEP?
LEEP may be done in a healthcare provider’s office, on an outpatient basis, or as part of the stay in a hospital. Procedures may vary depending on the patient’s condition and her healthcare provider’s practices.
Generally, LEEP follows this process:
- The patient will be asked to undress completely or from the waist down and put on a hospital gown.
- The patient will be instructed to empty her bladder before the procedure.
- The patient will lie on an exam table, with her feet and legs supported as for a pelvic exam.
- The healthcare provider will insert an instrument called a speculum into the patient’s vagina to spread the walls of the vagina apart to expose the cervix.
- Often, the healthcare provider will use a colposcope, an instrument with a special lens similar to a microscope, to magnify the tissues. The colposcope will be placed at the opening of the patient’s vagina but does not enter her vagina.
- The 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 the patient’s cervix may be made for her healthcare record.
- The patient’s 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. The patient may feel a mild burning sensation. An iodine solution is sometimes used to coat the cervix, called the Schiller test.
- The healthcare provider will numb the area using a small needle to inject the medicine.
- A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure. The patient may feel some cramping when the tenaculum is applied.
- The patient will hear humming and/or blowing sounds from the equipment.
- The LEEP wire will be inserted through the speculum and passed through the abnormal tissues. One or more passes may be needed. The patient may feel pressure or a slight cramping.
- Some women feel faint during the procedure. Tell the healthcare provider or the nurse if she is having this feeling.
- It is very important that the patient lies still during the procedure.
- The amount and location of tissues removed depends on whether LEEP is being used as a diagnostic tool, or to remove abnormal tissue. LEEP wires come in different sizes and shapes.
- 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.
- The tissue will be sent to a lab for further testing.
What happens after a LEEP?
After LEEP, the patient may rest for a few minutes after the procedure before going home.
The patient may want to wear a sanitary pad for bleeding. It is normal to have some mild cramping, spotting, and dark or black-colored discharge for several days. The dark discharge is from the medicine applied to your cervix to control bleeding.
The patient may be instructed not to douche, use tampons, or have sex for 4 weeks after LEEP, or for a period of time recommended by the healthcare provider.
The patient may also have other limits on her activity, including no strenuous activity or heavy lifting.
Take a pain reliever for cramping or soreness as directed by the healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
The healthcare provider will tell the patient when to return for further treatment or care. Generally, women who have had LEEP will need more frequent Pap tests.
Let the doctor know if the patient is having any of the following:
The healthcare provider may give the patient other instructions after the procedure, depending on what her situation is.