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The LEEP Procedure for HPV

You’ve probably seen commercials for the HPV vaccine. Hopefully, you’ve gotten the series of three shots to help prevent certain types of human papillomavirus that could lead to cancer. But if you do get HPV, you may have the common LEEP procedure completed with your doctor to remove unhealthy cervical cells.

What is HPV?

HPV is the most common sexually transmitted infection, and if you are sexually active, you will most likely get HPV at some point in your life. GASP! That sounds bad, right? It’s not bad in most cases. HPV is so common because it’s spread through skin-to-skin contact, and most of the time it doesn’t show symptoms. Most strains of HPV are no big deal and go away on their own, but some strains are harmful because they can turn into cancer.

Think of it like the common cold. Most people will get many colds throughout their lifetime. That’s not shameful or “dirty” or scary. No big deal. It will go away on its own, but in some cases, that cold could turn into something more serious like pneumonia or a sinus infection. That’s when you need to seek medical attention.

Types 16 and 18 of the human papillomavirus can lead to cervical cancer. If you have a vagina and are age 21 or over, or sexually active, you should be getting regular Pap smears to test for unhealthy cells on your cervix. If your doctor detects abnormal cervical cells, they will likely do an HPV test to see if that is the cause. Although HPV can cause unhealthy cells, HPV tests and Pap smears usually aren’t done together unless there is an abnormality. 

How does HPV relate to cancer?

You might be wondering, what even is my cervix? Where is it? Your cervix is a small area of tissue that connects your vagina to your uterus. Your vagina is the internal part of your genitalia and your uterus is also known as your womb. The cervix is kind of like a little cap at the top of the vagina. This is what prevents tampons or other things from getting lost in your body forever. The cervix is an important part of your body, so that’s why checking for healthy cells is so essential. 

If you have unhealthy cells on your cervix and have a positive HPV test, you’ll likely undergo something called LEEP. You and your doctor will of course discuss the best course of action to treat your unhealthy cells, but LEEP is a very common procedure to remove unhealthy cervical cells.

LEEP, or Loop Electrosurgical Excision Procedure, is done by your gynecologist in their office and removes unhealthy cells from your cervix. LEEP uses a wire heated by electrical current to scrape away the unhealthy cells. Sounds high-tech, right?! You don’t need to do anything to prepare for the LEEP procedure, although it is usually done when you’re not on your period, so if you have LEEP done, schedule it so it doesn’t happen while you’re menstruating. LEEP might hurt a little, so you could also take some Tylenol or Advil prior to the procedure. 

What can I expect from the LEEP procedure?

When you arrive at your doctor’s office, you’ll go into an exam room and undress from the waist down, similar to your Pap smear visit to the gynecologist. You’ll wear a gown and put your legs in stirrups so your doctor can see into your cervix. Your doctor will insert a speculum into your vagina to hold the vaginal walls open to have a clear view of your cervix. A speculum is made of metal or plastic and it honestly looks like a little beak that props open your vagina. Speculums are also used during Pap smears, so if you’ve had a Pap before, it’s the same thing. Once the vagina is open and the cervix is in view, your doctor might spray your cervix with a vinegar solution. This isn’t done with every LEEP procedure, but this solution turns the unhealthy tissue white, making it easier for your doctor to locate and remove it. After the solution is put into your cervix, you will be numbed. Your doctor will inject a numbing medicine into your cervix, then begin with the LEEP wire.

While holding very still, your doctor will put the wire through the speculum and into your cervix. Some doctors will also use a magnifying tool in your cervix to help see the unhealthy tissue clearer. The wire will take off the unhealthy tissue, your doctor will collect it, and send it to a lab for more testing. Because the wire uses electrical currents, it seals your blood vessels as it removes the unhealthy tissue, so you won’t bleed a lot during the procedure. The whole procedure takes about ten minutes and isn’t too painful. Since numbing medicine is used, most people only experience slight discomfort during the procedure. 

What happens after the LEEP procedure?

It takes about three or four weeks for your cervix to heal after the procedure, so don’t have vaginal sex, use tampons, or douche during this time. You should never douche ever, so don’t even worry about that one! Additionally, you’ll probably have some cramping for a day or so after the procedure, and you will probably bleed a little and have some watery discharge. The discharge can last for the whole healing process, and it might smell a little. This is normal! It’s also recommended to take it easy in general during the three to four weeks following the procedure. Don’t do any super intense physical activity. You need to allow your body some rest so it can heal. 

Are there any possible risks?

LEEP is a safe procedure, however, some serious complications could happen, although they are rare. Some people have pelvic infections, heavy bleeding, intense cramps or belly pain, fever, discharge that smells very bad, or bleeding that’s heavier than ever the heaviest day of your period. Additionally, LEEP may increase the risk of preterm birth in pregnancy. If you are currently pregnant and find abnormal cells, your doctor will wait until the pregnancy is over to do the procedure. 

If these possible side effects seem too severe or risky, talk to your doctor about other methods to remove unhealthy cells. LEEP isn’t the only method, although it is very common. Because HPV is so common and these unhealthy cells can turn into cancer, it is imperative that you get regular Pap smears! Encourage other people with vaginas in your life to go as well. Our vaginal and sexual health is super important, and although it might be uncomfortable or intimidating to think about, you need to stay on top of it.

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New Cervical Cancer Testing Guidelines

PAP smear tests are recommended every one to three years for people with uteruses ages 21 to 65. PAP smears help detect abnormal or unhealthy cells in one’s cervix, which could indicate cervical cancer. A recent update from the American Cancer Society is changing those requirements. On July 30 in the publication “CA: A Cancer Journal for Clinicians,” the American Cancer Society released updated requirements for cervical cancer screenings with new cervical cancer testing guidelines. Previously, people with cervixes would get a PAP smear every one to three years starting at age 21. An HPV test would be added as well once the patient is 30, and the PAP and HPV test would be done every one to three years until the patient is 65. The new recommendation is now phasing out PAP tests and simply testing for HPV every five years in patients ages 25-65.

Human papillomavirus is the most common sexually transmitted disease. Most people will have HPV at some point in their lifetime, and most cases of HPV are so mild that you won’t even know you’ve had it. Most cases also go away on their own. In some cases, however, HPV can develop into cervical cancer. These new recommendations suggest that testing specifically for HPV every five years will be a stronger way to detect cervical cancer than PAPs every three years. After a PAP test is done, if there are any abnormal cells in your cervix, an HPV test is ordered. These new recommendations would eliminate the PAP and just test for HPV right away.

The American Cancer Society says testing just for HPV every five years is a good idea due to the popularity of the HPV vaccine. Both boys and girls receive the vaccine now starting at age 11, greatly reducing the number of HPV cases. They also recommend starting HPV testing at age 25 because cervical cancer is incredibly rare in people under that age. The report said that the goal is to eventually phase out PAP smears altogether.

I’m not a doctor, but I do wonder if no longer having any PAP smears is a good idea. The PAP smear detects unhealthy cells in your cervix. Although HPV tests screen for cervical cancer, I wonder, what if you have unhealthy cells that aren’t due to HPV. How would that be detected then? Obviously this new requirement was done after much research and consideration, and like I said, I’m not a doctor, just curious.

I encourage you to ask your gynecologist about this new requirement in testing during your next visit. It’s important to be informed on your sexual health and know why procedures are changing and how that affects you. Regardless of the new requirements, it is important to start seeing your gynecologist for cervical health screenings regularly. The previous guidelines state starting at age 21 or once you become sexually active. Call your gynecologist and ask about the new HPV testing, or simply wait until your next scheduled appointment and chat about it then.

It’s incredibly important to stay on top of your sexual health and visit your gynecologist regularly. As I mentioned, HPV is very common and goes away in most cases, but just in case, it is super important to get tested regularly, whether that be according to the old guidelines or the new.

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