LEEP Cone Biopsy

LEEP stands for Loop Electrosurgical Excision Procedure. It is used to treat significant dysplasia and can usually be done in the office. This is done after a colposcopy that confirms dysplasia. The LEEP is not painful and most women say that it is less painful than the colposcopy. It should cure the cervical dysplasia. There is typically bleeding and discharge for about 2 weeks after the procedure.

Lidocaine with epinephrine is used to numb the cervix. This surprisingly does not hurt when it is injected into the cervix, although it may cause mild cramping. The epinephrine helps decrease bleeding but it can cause a rapid heart rate for a minute or two after it is placed in the cervix. It can also cause a head rush sensation. For most women this rapid heart rate is the worst part of the entire procedure.

A small tissue biopsy is taken with the LEEP, about the size of a US nickle. The bed is then treated with cautery and sometimes a chemical called silver nitrate or monsel’s solution to control bleeding. There should not be any pain after the LEEP; women are able to safely drive themselves home or return to work after the procedure.

Patients are asked to return for follow-up two weeks after the procedure to check the cervix and discuss the results of the pathology. During the two weeks after the procedure women are asked to be on pelvic rest which means nothing in the vagina, no sex, no tampons, no douching, etc.

To understand a LEEP, think of an apple with a brown spot in the apple. If you want to eat the apple you will take a knife and cut the bad part out. This makes the apple good again. LEEP is this concept. There is a small part of the cervix that has a bad part (dysplasia). The LEEP cuts out the bad part and leaves the rest of the cervix in good condition.

The most common concern regarding LEEP is the long term risk of cervical incompetence. Cervical incompetence is when the cervix is not strong enough to hold in the baby while pregnant. This can lead to second trimester pregnancy loss or preterm delivery. Early studies seemed to link LEEP with this problem. The latest data has shown that women that have had LEEPs are not at increased risk of pregnancy complications. So LEEP is safe without needing to worry about future problems with pregnancy.