Loop electrosurgical excision procedure (LEEP)

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, CTCA Program Director, Gynecologic Oncology.

This page was reviewed on May 18, 2022.

A loop electrosurgical excision procedure (LEEP) helps with the diagnosis and treatment of abnormal cells or cancer found in the cervix.

The LEEP uses a thin wire loop that’s heated by an electric current. The wire loop comes in different sizes and acts as a surgical knife, cutting away at the abnormal tissue. The tissue is then sent to a laboratory for further analysis.

There are a few reasons your doctor may recommend a LEEP:

  • To diagnose precancerous changes in the cervix and cervical cancer (precancer refers to abnormal cells that could become cancer)
  • To figure out the cause of an abnormal Pap test result
  • To treat precancerous conditions and early-stage cancer in the cervix

How to prepare for a loop electrosurgical excision procedure

There are a few things you can do ahead of your LEEP appointment:

  • Make sure to schedule the LEEP when you’re not going to be menstruating.
  • Inform your care team of all medications you use, as well as any herbal supplements. If you use blood-thinning medicines, aspirin or other drugs that affect blood clotting, your provider may ask you to stop them temporarily before you undergo the procedure.
  • Let your care team know if you are or might be pregnant.
  • Don’t use douches, tampons or vaginal creams before the procedure. Your care team will let you know how far in advance to stop these.
  • Don’t have vaginal sex before the procedure.
  • Ask whether you should take pain-relieving medication beforehand. Follow any instructions on what type of medication to use.
  • Consider taking a sanitary napkin with you to wear home when the LEEP is done. You may experience some bleeding or discharge.

What to expect from a loop electrosurgical excision procedure

The LEEP is usually performed in your doctor’s office, though at times, some providers may choose or prefer to perform it in the operating room. The procedure lasts a few minutes.

For the procedure, you remove all clothes from the waist down and empty your bladder. Then you lie down with your legs in stirrups, similar to when you have a pelvic examination. The doctor places a speculum in your vagina to open the vaginal canal.

  • The doctor typically administers local anesthesia intravenously. This type of anesthesia is used to numb just the cervical area.
  • Many doctors use a colposcope, which is an instrument with a special lens, to better visualize the tissues. This device is placed at your vaginal opening, but it doesn’t go inside your vagina. The doctor may take photos using the colposcope for your health records.
  • Your doctor may place a special vinegar solution on the cervix to make any abnormal tissues easier to see. Then, the loop is inserted through your vagina and to the cervix. The loop can remove abnormal tissue and take a tissue sample for analysis.
  • Once finished, you may have a paste-like medicine, called Monsel's paste, which is applied to your cervix to help control bleeding.

During the LEEP, you may feel some dull cramping. It’s also possible that you’ll feel as if you’re going to faint. If this happens, alert your doctor.

Most women can resume their normal activities after one to three days. However, your doctor may advise you to not have sex, douche or use tampons for about two to four weeks after the LEEP. You may also need to avoid strenuous activities and heavy lifting for a period of time.

Benefits and risks of a loop electrosurgical excision procedure

The benefit of the LEEP is that it can help remove precancer or early-stage cancers from your cervix or vagina.

There are some LEEP-related side effects, including:

  • Cramping similar to that during menstruation
  • Dark brown discharge in the first week. This is from the solution that may be used on the cervix
  • Small amounts of blood from the vagina in the following three weeks

The LEEP also may cause more serious side effects, though these aren’t as common. They include:

  • Fever, intensifying pain and discharge from the vagina that has a bad smell (these may indicate a possible infection)
  • Heavy bleeding
  • Pain that doesn’t subside with medicine

Let your doctor know right away if you have any of these more serious side effects.

A small number of women may have trouble getting pregnant after undergoing the LEEP or may deliver a baby earlier if they get pregnant. Rarely, though, it is also possible to experience changes to your menses, like having more painful periods.

Reviewing the results of a loop electrosurgical excision procedure

Your doctor sends any tissue samples to a pathologist, who can study them under a microscope. The pathologist writes a report stating whether the tissue samples are normal or indicate precancer or cancer. Discuss any questions that you have with your care team.

Depending on the results, you may need to have additional tests or treatments to make sure all abnormal tissue was removed or doesn’t recur. Your doctor may ask you to return for more frequent Pap tests after you have had a LEEP.

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