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LEEP Procedure

A LEEP procedure is completed when patients have High Grade Lesions of the cervix.  A high grade lesion is identified during colposcopy (link) and is considered a pre-cancerous change to the cervix.

LEEP stands for Loop Electrode Excisional Procedure. It is a 10-15 minute office procedure for abnormal cells of the cervix. During the procedure a small (8-12 mm) wire loop powered by an electrical current carefully removes a small layer of affected cells from the cervix.

The purpose of a LEEP is to remove all abnormal cells on the cervix, to eliminate the HPV virus, and reduce (or eliminate) your risk of cervical cancer.

  • Do not have sexual intercourse 48 hours before your procedure
  • Do not use lubrication
  • Do not use a douche prior to the test
  • If you are pregnant, inform your doctor when you meet for your procedure
LEEPs are completed at colposcopy clinic which is currently located at the Queensway Health Centre at 150 Sherway Drive , Toronto M9C 1A4.
It is located on the ground floor in Surgical Clinic B.  (Please go to patient registration upon arrival)


If you have been instructed to go to Credit Valley Hospital, please go here
A colposcopy is completed in several steps.
  1. Register at the hospital.  Once registered, a volunteer will bring you to the colposcopy clinic.
  2. Get changed and ready for your procedure.
  3. The nurse will bring you into the exam room and help you get comfortable for the procedure.
  4. Your doctor will use a speculum to look inside the vagina to see the cervix.
  5. The colposcope is positioned so the doctor can see properly.  The colposcope will be between your knees but does not enter the vagina.
  6. The doctor will use some gauze to apply a solution (acetic acid) to cervix to help see better.  This will usually feel cold and sometimes there is mild burning.  A second solution will also be applied.
  7. The solutions will help identify any abnormal areas.
  8. Local freezing will be given using a fine needle.  This may burn for a brief period of time.
  9. While waiting for the freezing to work, the doctor will set up for the LEEP procedure.
  10. With the cervix now frozen, the doctor will complete the LEEP and remove the small specimen.  This may be in one or two steps.  Although this is a little noisy, it should be painless.
  11. Once the specimen is removed, a test from inside the cervix will be completed.  This may cause some mild cramping.
  12. The doctor will use the cautery machine to make sure there is minimal bleeding.  Although this is a little noisy and may take a few minutes, it should be painless.
  13. At the completion of the procedure, the speculum will be removed and when you are ready you may go.
After your LEEP procedure you will have bleeding for up to 6 weeks.  This is normal and may be similar to a period.  Most people will also experience a normal period during their recovery. During the 6 week recovery period please
  • Do not have sexual intercourse
  • Do not use tampons
  • Do not take a bath or go swimming (you may take a normal shower)
LEEP is a safe procedure, but there are some risks.  These include:
Bleeding
  • Light to moderate bleeding is expected for up to 6 weeks.
  • Although very rare, if there is very heavy bleeding (soaking through 3-4 pads in 2 hours), please go to the emergency room.
Infection
  • This is also very rare. Antibiotics are not provided during a LEEP procedure, but if you develop significant pelvic pain, discharge with pus, or fever please go to the emergency room for assessment
Recurrence
  • Unfortunately, there are times when a LEEP procedure does not remove the entire abnormality and a second procedure is required.
  • Similarly, as a LEEP is performed for high grade changes on the cervix, which come from exposure to high-risk HPV, some patients get exposure to another form of HPV and develop a completely new lesion. (This is why vaccination is important.)
Pregnancy
  • Patients who have had high grade changes and/or LEEP procedures are at slightly increased risk of having some complications of pregnancy. These include early rupture of membranes and preterm labour.
Cervical Stenosis
  • Very rarely, the cervix may close down completely after a LEEP procedure. This creates challenges for follow up assessments and can cause fertility issues in younger patients.

All patients who have a LEEP will require 2 or more follow up assessments.

Yes

Usually we try to avoid a LEEP during pregnancy.  Please talk to your doctor.

Maybe.  The IUD itself will not be affected by the LEEP procedure, but frequently the strings (which are required for easy removal) can be cut.  Patients with IUDs have 3 choices.
  1. Leave the IUD in, allowing the strings to be cut. Expect a more difficult removal when the time comes.  (This is not very popular).
  2. Leave the IUD in, but try to push the strings up out of the way during the procedure. If successful, the strings can be brought back down once the procedure is completed.  The problem with this approach is the strings may get cut anyway, or get stuck higher in the uterus.  If this happens, the IUD may be left alone (as above) or removed during the LEEP before extraction becomes too difficult.
  3. Remove the IUD and either replace with a new one or use another form of birth control.

A LEEP procedure remains the preferred treatment for high grade changes to the cervix. In rare circumstances other methods such as laser may be recommended.

The most important reason we complete LEEP procedures is to reduce the risk of cervical cancer.  Patients who choose not to have a LEEP are at risk of developing cervical cancer over time.  The risk of cancer depends on many factors including how long the high grade changes have been present and your age.
Once your LEEP is completed, our goal is to get you back to routine cervical cancer screening with your family doctor.  Most patients will test negative for HPV following a LEEP.  This means the risk of cervical cancer is the same as the general population. But remember, as high grade changes can be caused by many different versions of HPV there is always a chance of exposure to another form of HPV, so continuing ongoing screening will be important for  many years.

http://www.hpvinfo.ca

http://www.ontariohealth.ca/cervical-test

https://gynqi.com/colposcopy/

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