What is a 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.

Why might I need a LEEP?

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, 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.

What are the risks of a 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

How do I get ready for a LEEP?

• 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 your provider 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.

What happens during a LEEP?

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 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 one 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.

What happens after a LEEP?

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:

• Heavy bleeding

• Bleeding with clots

• Foul-smelling drainage from your vagina

• Fever, chills, or both

• Severe abdominal pain

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

Next steps

Before you agree to the test or 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 you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure