LEEP: One Treatment Option for Women with HPV
By Shannon Farley
Women routinely get Pap smears to ensure that there are no abnormal changes to the tissues in the cervix. However, each year between 5-10 percent of women may have a Pap smear that returns a report of abnormal tissue on the cervix. If this happens, do not fret! There are a variety of reasons the tissues may be abnormal and it does not necessarily mean that a woman has cancer.
The most common cause of these changes to the cervical tissue is the human papillomavirus, otherwise known as HPV. But HPV is not the sole cause of an abnormal Pap test, as other factors such as bacteria, yeast, and the normal course of aging can cause changes to the cervix, as well as the whole body. Sometimes, these changes in the cervical tissue may become cancerous, but in most cases the abnormal tissues depart on their own or they can be treated.
Before beginning any type of treatment after receiving an abnormal Pap test result, the doctor may repeat the Pap test and possibly run additional tests to determine the best course to follow.
There are a variety of tests that can be used for follow-up. A colposcopy involves using a colposcope to view the vagina and cervix. A colposcope is a special tool that magnifies and lights the reproductive tract. This allows the doctor to see the cervix and the abnormal cells more clearly. Endocervical cutterage is a method where cells from the cervix are scooped out with a curette to be examined further. Another option is a biopsy, where a sample of tissue is removed and examined under a microscope. All additional testing methods will clearly show the doctor what changes are happening to the cells of the cervix. If the changes are mild, treatment will not be necessary; if the changes are more severe, treatment may be necessary to remove the abnormal tissue.
While most cases of abnormal Pap smear results are due to an HPV infection in the cervix, most types of HPV do not cause cervical cancer to develop; rather, most types of HPV infection eventually disappear on their own after about a year and a half in women under the age of 30. For women over the age of 30, the infections are more likely to continue. After conducting the additional tests, the doctor can tell what type of HPV is causing the abnormality and whether or not treatment will be needed to remove the tissue because of moderate or severe abnormalities, or just wait for them to disappear on their own.
If the HPV has resulted in moderate or severe changes to the cervical tissue, and the strain of HPV is one of the potentially cancerous strains, the doctor will discuss options for treating the abnormal tissues. It is important to treat these abnormal tissues to help prevent cervical cancer from developing. The treatment of focus in this article is LEEP, or the Loop Electrosurgical Excision Procedure (LEEP). LEEP uses electricity to cut out the abnormal tissue by using an electrified wire loop that is very thin. The tissue that is removed is then examined to find out exactly what type of abnormality it is.
LEEP is an outpatient procedure that a woman can have in the doctor’s office. It begins like any normal gynecological examination with a speculum being inserted into the vagina. Next, the cervix is numbed, and sometimes a local anesthetic is used. Then the electrified loop is inserted into the vagina, moved up to the cervix and used by the doctor to cut off the abnormal cells. If a woman experiences feelings of faintness during the procedure, she should tell the doctor right away. Women should not be concerned if they smell or see some smoke during the procedure. LEEP burns the tissue and smoke will often be the result. (No smoking signs can be ignored.) After the tissue has been removed, either a paste or electrocautery (using heat to stop bleeding) may be used to stop any bleeding that occurred during LEEP.
LEEP can be conducted during pregnancy to remove moderate or severe abnormal cervical tissue; however, doctors do try to delay the procedure: Waiting to have LEEP until after delivery is considered safe because the transition from abnormal tissue to cancerous tissue is usually a slow process.
Women do need to allow at least one and up to as many as three days of recovery time after having LEEP. The most common after effects may include some cramping and discharge from the vagina that may be red or pink or brown. This is from the paste used to stop the bleeding.
Women should wait at least three weeks before putting anything into the vagina, including tampons or any form of sex toy. Having sex before the cervix is completely healed may lead to an infection in the pelvic region. If severe abdominal pain, or any heavy bleeding, or clots, or any yellowish discharge, or fever persist, call the doctor immediately!
After having LEEP, women need to get repeat Pap smears every few (3-6) months for about two years to check for recurring growth of the abnormal tissue. Talk to the doctor about what follow-up Pap smear schedule is recommended.
There is some controversy over the frequent use of LEEP. Some doctors believe the procedure is being used too often by those not appropriately trained and sometimes too much cervical tissue is being removed. LEEP may occasionally result in injury to additional pelvic organs. There are also other concerns with the procedure, sometimes after having LEEP, the cervix can become narrowed which may lead to problems with both getting pregnant and menstruation. Women should also know that LEEP has been associated with a slightly higher risk of having a premature birth and having low birth-weight babies.
While HPV is a very common infection that often clears itself from the cervix, there are strains of HPV that can cause cervical cancer. It is important to get the abnormal cells treated so that they do not have time to develop into cervical cancer. The Loop Electrosurgical Excision Procedure is a safe procedure that can be used to remove moderate or severe abnormal cervical tissue usually caused by an HPV infection.
LEEP does have common side effects such as colored discharge or pain. If the discharge becomes yellow or the pain is severe, a woman should contact her doctor immediately. There are more severe side effects that can happen rarely after having LEEP. The cervix can narrow, which may affect menstruation or getting pregnant. There is a slight increase in the chance of having a low birth-weight baby. It is up to each woman and her doctor to decide if the risk of cervical cancer is greater than the risk of these infrequent but possible side effects.