Julianne M. Dunne, MD

What is a LEEP cone biopsy?

LEEP (or the Loop Electrosurgical Excision Procedure) is a procedure used to treat dysplasia by removing the abnormal cells from your cervix.  LEEP uses a thin wire loop that acts like a scalpel (a surgical knife).  An electric current is passed through the loop, which cuts away a thin layer of the surface cells. This allows new healthy cells to grow.

Why is my doctor recommending I have a LEEP?

LEEP cone biopsy is a treatment for dysplasia (abnormal cervical cells with cancerous potential).

What should I expect during the LEEP?

LEEP is performed here in the office and only takes a few minutes. It is best done when you are NOT having your period.  As with a pelvic exam, you will lie on your back with your feet raised and placed on foot rests for support.  A speculum will be used to spread apart the vaginal walls so that the inside of the vagina and the cervix can be seen.  A solution is applied to your cervix with a cotton swab to show abnormal cells. Colposcopy is used to magnify the cervix during the surgery.

The loop is inserted through the vagina to the cervix.  There are different sizes and shapes of loops that can be used.  After the procedure, a special paste may be applied to your cervix to stop any bleeding.  The tissue that is removed is sent to a laboratory for evaluation.

Is the LEEP painful and if so will I receive anesthesia?

LEEP can be easily performed while you are awake under local anesthesia injected directly into your cervix.  However, it is more uncomfortable than the biopsies performed during colposcopy.  In our office, we can offer to do the procedure while you are asleep under intravenous sedation or general anesthesia provided by our anesthesiologist.  You will wake up immediately after the procedure is completed and have some mild crampy discomfort.

What are the advantages of LEEP?

LEEP is a simple office-based procedure:

It is appropriate for most degrees of cervical dysplasia 

It is more effective than destructive techniques such as cryosurgery or laser

Abnormal cells are removed and sent to the laboratory for evaluation

This biopsy confirms the diagnosis and

The specimen is evaluated to ensure the entire abnormality was removed

What are the disadvantages of LEEP?

Although problems seldom occur with LEEP, there can be some minor complications.

Small risk of bleeding

Risk of infection

Theoretical risk of fertility issues--cervical stenosis and incompetent cervix

Not a cure for HPV—there is risk of persistence of infection or reinfection

When do I follow-up after the LEEP?

You will be scheduled for a post-operative visit about two weeks after the procedure to examine the biopsy site and discuss the results of the biopsy.  After this visit, if your exam is normal, you may return to your usual activities.

After the LEEP, you will be followed with Pap tests every 3 months.  After one year of normal results, you may return to the routine screening interval.  This is done because the LEEP can only remove the abnormal cells from the cervix but does not treat the cause of these abnormalities, which is the Human Papilloma Virus (HPV).  With presence of active HPV, there is risk of developing abnormal cells again.

Is there anything I can do to prevent these abnormalities in the future?

By making a few lifestyle changes, you can help protect the health of your cervix:

                Have regular pelvic and Pap tests

                Stop smoking (smoking increases your risk of cancer of the cervix)

If you have more than one sexual partner, limit your number of partners and use condoms to reduce your risk of sexually transmitted infections

LEEP Cone Biopsy

POST-OPERATIVE INSTRUCTIONS

How long is the recovery after a LEEP?

It may take a few weeks for your cervix to heal.  While your cervix heals, you may have:

                Vaginal bleeding (less than a normal menstrual flow)

                Mild cramping

                A brownish-black discharge (from the paste used)

What activities should I avoid?

For two weeks after the procedure, you should not have sex, take a tub bath, or douche. 

What should I look out for after the LEEP?

You should call the office if you have any of the following:

                Heavy bleeding (soak through more than 1 menstrual pad per hour for 2 or more hours)

                Severe abdominal pain

                Fever (more than 100.4°F)

                Foul-smelling discharge

Cold knife cone biopsy (CKC) biopsy is a procedure used to treat dysplasia by removing the abnormal cells from your cervix.  It uses a surgical scapel to cut away a thin layer of the surface cells. This allows new healthy cells to grow.

Cold knife cone biopsy is a treatment for dysplasia (abnormal cervical cells with cancerous potential).  It will provide clearer margins (or edges) that a LEEP procedure. This is because a surgical scalpel will be used rather than cautery. Cautery may burn the edges of the specimen making it more difficult for the doctor examining the specimen to get  a clear reading.

What are the advantages of CKC compared to LEEP?

It provides clearer margins compared to LEEP. If your case is more complicated this may be important for your care.

What are the disadvantages of CKC?

Although problems seldom occur with CKC, there can be some minor complications.

Small risk of bleeding (more than with the LEEP)

Risk of infection

Theoretical risk of fertility issues--cervical stenosis and incompetent cervix

Not a cure for HPV—there is risk of persistence of infection or reinfection

You will be scheduled for a post-operative visit about two weeks after the procedure to examine the biopsy site and discuss the results of the biopsy.  After this visit, if your exam is normal, you may return to your usual activities.

After the CKC, you will be followed with Pap smears at an interval determined by your doctor. After one year of normal results, you may return to the routine screening interval.  This is done because the LEEP can only remove the abnormal cells from the cervix but does not treat the cause of these abnormalities, which is the Human Papilloma Virus (HPV).  With presence of active HPV, there is risk of developing abnormal cells again.

By making a few lifestyle changes, you can help protect the health of your cervix:

 Have regular pelvic and Pap tests

 Stop smoking (smoking increases your risk of cancer of the cervix)

 If you have more than one sexual partner, limit your number of partners and use condoms to reduce your risk of STDs

It may take a few weeks for your cervix to heal.  While your cervix heals, you may have:

                Vaginal bleeding (less than a normal menstrual flow)

                Mild cramping

                A brownish-black discharge (from the paste used)

For two weeks after the procedure, you should not have sex, take a tub bath, or douche. 

You should call the office if you have any of the following:

                Heavy bleeding (soak through more than 1 menstrual pad per hour for 2 or more hours)

                Severe abdominal pain

                Fever (more than 100.4°F)

                Foul-smelling discharge