Have you ever heard of a loop electrosurgical excision procedure? If not, you’re not alone. While most of us are familiar with Pap smears and pelvic exams, loop electrosurgical excision procedure — commonly referred to as LEEP — is a women’s health procedure that doesn’t get a lot of press. Though it’s not a commonly discussed procedure, it’s a vitally important one that can save lives.
According to the American Congress of Obstetricians (ACOG), LEEP is a treatment to remove precancerous cells from the cervix, which can stop them from turning into cancer.
Because it’s rarely discussed, people may be confused or even scared when they’re advised to have the procedure. That can make the prospect of actually undergoing this procedure especially scary. That’s why it’s important to break it all down — from what people can expect from the procedure itself, to what LEEP can tell a patient about their health, to demystifying common concerns about the procedure’s impact on long-term reproductive health.
Ob/Gyn Staci Tanouye, MD is on hand to answer our most pressing questions.
First of all: Why might someone need LEEP?
“When someone has an abnormal Pap smear, depending on the result and their age, they may need an exam called a colposcopy that examines the cervix close up in more detail and usually involves taking tiny pinch biopsies of areas that appear abnormal,” says Dr. Tanouye. “If any of these tiny biopsies demonstrates a high-grade precancerous lesion on the pathology report, then a LEEP may be one of the options offered to remove all of the abnormality present in a larger biopsy.”
What does the LEEP procedure entail?
You may be wondering how the procedure gets its name. (Refresher: LEEP stands for Loop electrosurgical excision procedure). The term nods to the mechanism used to perform the procedure.
“It is a small wire loop that is connected to an electrocautery machine so that when it is turned on, energy/heat passes through it and allows it to cut through tissue,” says Dr. Tanouye. “These wire loops are used to take a larger biopsy of the cervix.”
According to ACOG, the procedure starts similarly to a pelvic exam, with an OB/GYN inserting a speculum into the vagina. The wire loop is passed over the cervix, where it removes abnormal cells so they can be sent to a lab for testing.
Ouch! Sounds…unpleasant. Is any sort of pain medication or sedation available for patients?
The good news? The procedure only takes about 5-10 minutes. Having a speculum placed inside the vagina for that long can be uncomfortable, but this usually doesn’t cause significant pain.
The procedure isn’t exactly fun, but it shouldn’t hurt.
“LEEPs can be done in the office with local anesthesia, meaning injecting lidocaine numbing medication into the cervix so it becomes numb. While the injections are uncomfortable after they are completed, the patient should not feel the LEEP at all,” says Dr. Tanouye.
If you have this procedure done in an office with surgery capabilities or in a hospital, you may also have the option of sedation.
What can a LEEP tell a provider about a patient's health?
This procedure can be used to determine whether a person’s cells are precancerous or indicate cervical cancer.
“These results will help us determine what kind of follow-up we need to do to make sure the precancerous changes do not progress into cervical cancer,” says Dr. Tanouye. “One of the primary purposes of a LEEP is to prevent invasive cervical cancer by removing significant precancerous changes before they progress further.”
What’s recovery like after the LEEP procedure?
“The main limitation is to put nothing in the vagina for around 3-4 weeks including no tampons or penetrative sex,” says Dr. Tanouye. “In addition, [avoid] swimming in lakes, oceans, or public pools to prevent infection. Besides that, there are no other physical limitations and people can usually go back to their daily activities either the same or the next day. Patients may also notice a lot of discharge for a few weeks after.”
Some people worry about how this procedure will affect their fertility down the line. Is there any reason for concern?
“LEEPs do not affect fertility or the ability to get pregnant,” assures Dr. Tanouye. “However, because a LEEP can alter the cervix, this may increase risk that the cervix may dilate too early during a pregnancy which can increase risk of miscarriage or preterm labor. This is certainly true after multiple LEEPs, however, the research is a little conflicting about the risk after one LEEP.”
Here’s what you need to know if you’re undergoing this procedure
“The best thing to do is talk to your doctor about it,” advises Dr. Tanouye.
She’s right: Information is power, and preparedness is key.
“Write down all of your questions so you understand and remember what you talk about,” adds Dr. Tanouye. “Ask about your options for pain control so you can pick what sounds best to you. It may be helpful to bring a friend or family member to hold your hand and talk to provide distraction.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.