Loop Electrosurgical Excision Procedure (LEEP)

What happens before LEEP?

Your healthcare provider will ensure you don’t have any conditions that may prevent you from getting the procedure. For instance, you shouldn’t have a LEEP if you have acute pelvic inflammatory disease (PID) or inflammation of your cervix (cervicitis). You may need to take a pregnancy test before getting a LEEP. Your provider can advise you on the right timing for a LEEP if you’re pregnant.

If there aren’t any contraindications, your provider will schedule the procedure at a time when you’re not menstruating, ideally one week after your period ends.

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Follow your provider’s instructions about how to prepare. Your provider may advise you to:

• Avoid having intercourse or using vaginal creams or douches 24 hours before the procedure.
• Pack a pad that you can wear after the procedure to handle any vaginal discharge.
• Stop taking medications that affect how your blood clots, like anticoagulants or aspirin.
• Take a pain reliever like ibuprofen (Motrin®) or acetaminophen (Tylenol®) 30 minutes before the procedure.
• Wear loose-fitting clothes that you can easily remove and replace with a hospital gown on the day of your procedure.

How is LEEP (loop electrosurgical excision procedure) performed?

A LEEP can occur in your gynecologist’s office or in a hospital or outpatient setting.

Preparing for the procedure

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LEEP begins much like a regular pelvic exam. Though you’ll remain awake throughout the procedure, you should feel only minor discomfort. First, your provider will ask you to lie back and rest your feet in stirrups at the end of the exam table. A grounding pad will be placed on your thigh to protect you from the electricity used during the LEEP. Your provider will widen your vagina with a speculum to get a clearer view of your cervix.

A very dilute solution of acetic acid or Lugol’s solution (Iodine) will be added to your cervix to make the abnormal cells visible. Your provider will then place a colposcope near the opening of your vagina. The colposcope will remain outside of your vagina, providing a magnified view of your cervix.

Numbing your cervix

Your provider will use local anesthesia (lidocaine) to numb your cervix. During the injection, you may notice tingling in your tongue, ringing in your ears or a rapid heart rate. If this occurs, it lasts for only a few minutes. Once your cervix is numb, your provider will insert an electrically charged loop made of thin wire through the speculum until it reaches your cervix.

Removing the abnormal tissue

You must remain perfectly still during the tissue removal process. As the loop passes across your cervix, it cuts away a thin layer of surface tissue, removing abnormal cells. Sometimes, your provider will use a second loop to reach a little higher in your cervix. This tissue will be tested later for cancer or abnormal cells.

Stopping the bleeding

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Finally, your provider will apply a medicated paste (an iron solution called Monsel’s paste) to the area to stop and prevent bleeding.

How long does LEEP take?

The procedure takes 10 to 20 minutes. You’ll be able to go home afterward as soon as you feel up to it.

How painful is the LEEP procedure?

You may feel a small pinch or a sensation like a bee sting when your provider injects the lidocaine into your cervix. Or, you may not feel any sensation at all. You may feel internal pressure or slight discomfort when the cells are being removed. Still, you shouldn’t feel pain because your cervix will be numb from the anesthesia.

Although the sensations feel more like pressure than pain, some people report feeling lightheaded during the procedure. Let your provider know if you start to feel faint at any point during the LEEP.

What happens after LEEP?

Afterward, you may feel lightheaded and need to rest in your provider’s office until you’re comfortable enough to drive home. For many people, this rest period takes less than 30 minutes. You’ll receive aftercare instructions to aid in your recovery.

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