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What is LEEP?
Loop electrosurgical excision procedure (LEEP), uses a low-voltage electrical current to remove abnormal tissues of the cervix. It has an advantage, therefore, over the destructive techniques (CO2 laser and cryocautery) in that an intact tissue sample for analysis can be obtained. LEEP also is popular because it is inexpensive, simple, and typically has few risks or side effects. LEEP is also known as large loop excision of the transformation zone (LLETZ).
This procedure is used most often for treating moderate dysplasia (abnormal changes of the cells lining the cervix or precancers) that have been identified by colposcopy and/or cervical biopsy. In certain situations, severe dysplasia and noninvasive cancer that are localized and can be removed, may also be treated by LEEP.
How is a LEEP done?
The patient lies on an examining table with the feet elevated in stirrups (the position used to obtain a Pap smear). A speculum (as used for the Pap test) is inserted to open the vaginal walls. Sometimes a special solution, either vinegar (acetic acid) or iodine, is applied to the cervix prior to the procedure, which makes the abnormal areas of tissue more recognizable).
The area is numbed using a local anesthetic (cervical block). Oral or intravenous medications to control pain may also be given. A low-voltage electrical current is delivered via a thin wire that is passed through tissues to remove the abnormal areas of the cervix. A chemical is applied afterwards to prevent bleeding.
Mild pain and cramping that can be relieved by oral medications may occur for the first few hours following the procedure. Vaginal discharge and spotting commonly occur after this procedure for up to a few weeks. Sexual intercourse and tampons use should be avoided for several weeks to allow better healing. Douching should also be avoided.
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How effective is LEEP?
LEEP has been shown to be comparable to cryotherapy, cold knife conization (surgical removal of the abnormal area), laser ablation (destruction of the abnormal tissue), and laser conization for the removal of abnormal or precancerous tissues of the cervix. Studies have shown that a majority of these methods result in a cure (removal of all the affected tissue).
Further treatment is not typically necessary if all of the abnormal area has been removed, although the precancerous changes may develop again (recur) at a later time. Regular follow-up Pap tests are required following LEEP to evaluate for possible recurrence of the cellular abnormalities.
What are complications of LEEP?
Complications occur in about a small percentage of women undergoing LEEP, including narrowing (stenosis) of the opening of the cervix, greater than expected amounts of bleeding, or infection of the cervix or uterus.
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Wright, Jason D., M.D. "Patient information: Management of a cervical biopsy with precancerous cells (Beyond the Basics)." Uptodate.com. Updated Jan. 18, 2016.
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Cancer PreventionCertain behavioral, lifestyle, and environmental factors contribute to cancer. Cancer prevention involves modifying these factors to decrease cancer risk. Tobacco use, alcohol consumption, physical inactivity, inadequate fruit and vegetable intake, and obesity increase the risk of certain cancers. Vaccines, genetic testing, and cancer screening also play a role in cancer prevention.
Cervical CancerCervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
ColposcopyDuring a colposcopy procedure, the vulva, vaginal walls, and uterine cervix is examined to detect abnormalities that may suggest diseases. Tests performed during colposcopy include acetic acid wash, color filter, or biopsy of the cervix. Treatments for cervical abnormalities include:
- carbon dioxide laser photoablation,
- LOOP (LEEP),
- cold knife cone biopsy, or
CryotherapyCryotherapy, sometimes referred to as cryosurgery, is a pain treatment procedure that uses a method of localized freezing temperatures to deaden an irritated nerve. Cryotherapy can be used to treat nerve irritation between the ribs (intercostal neuralgia), cluneal nerve entrapment, ilioinguinal neuroma, hypogastric neuromas, lateral femoral cutaneous nerve entrapment, and interdigital neuromas, nerve entrapment (pinched nerves), and neuromas.
Pap SmearA Pap smear (Pap test) is a medical procedure to screen for abnormal cells of the cervix. A woman should have her first Pap smear (in general) three years after vaginal intercourse, or no later than 21 years of age. The risks for women at increased risk for having an abnormal Pap smear include: HPV (genital warts), smoking, a weakened immune system, medications (diethylstilbestrol), and others. Some of the conditions that may result in an abnormal Pap smear include: absence of endocervical cells, unreliable Pap smear due to inflammation, atypical squamous cells (ASCUS), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), cervical intraepithelial neoplasia (CIN), and carcinoma in situ.
Surgery QuestionsSurgery is the branch of medicine that employs operations in the treatment of disease or injury. Prior to surgery you might consider asking your surgeon questions about the operation (procedure).
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions that may include:
- Uterine fibroids
- Pelvic inflammatory disease
- Emotional stress
- Anorexia nervosa
- Polycystic ovary syndrome (PCOS)
- Early pregnancy
The treatment for abnormal or irregular vaginal bleeding depends upon the cause.
Vaginal Douche (Douching)Women douche for a variety of reasons, however, physicians do not recommend douching. Douching can change the vaginal flora, and make women more prone to vaginal infections. Health problems linked to douching include STDs, pelvic inflammatory disease, and vaginal irritation.
Women's HealthWomen's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.