From your recent Pap smear, your doctor has determined that you have a disorder of the uterine cervix (the entrance to the womb). This disorder, called Cervical Intraepithelial Neoplasia (CIN), is a change in the surface cells of the cervix. The presence of CIN does not mean that you have cancer, but detection and treatment of CIN is important to avoid the possible development of cervical cancer.
CIN is a lesion of abnormal cells typically associated with the Human Papilloma Virus (HPV). When HPV is contracted, it infects the cells of the transformation zone of the cervix. The transformation zone is the area of cervical tissue where the cells actively divide and grow. As these cells grow and mature, they are pushed to the surface as new cells are produced and the older, outside cells die and are shed. When the virus infects the cell and then becomes active, abnormal cells begin to be produced in the transformation zone and a lesion develops.
Removal of the lesion is an effective treatment for CIN. Although HPV remains once the CIN lesion is removed, the rate of recurrence of CIN is quite low since the removal of the transformation zone eliminates the tissue most susceptible to CIN.
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LEEP for the management of CIN is rapidly replacing such methods as cryosurgery (freezing), laser surgery, and traditional excision surgery for some types of lesions. Unlike other treatment methods, this technique allows the physician to have the excised specimen studied by a testing laboratory (pathology). The pathologist's test is important because: 1) it ensures that the lesion was completely removed, and 2) it allows for more accurate assessment of the abnormal tissue.
Prior to arriving at the office for the procedure, your doctor may advise you to take some ibuprofen, naprosyn, or other pain reliever. This will help to minimize any discomfort during or immediately after the excision procedure. Please follow your doctor's pre-procedure instructions carefully.
The procedure will take 10 to 30 minutes. You will lie on the examination table with your feet in the stirrups: A vaginal speculum will be placed and the colposcope (microscope) will be set up; just as in a routine exam. To prepare the equipment for use, a tube will be connected to the speculum to remove the small amount of smoke that will be generated by the procedure. An electrosurgical dispersive pad will be placed on your thigh. This pad is a gel-covered adhesive electrode that provides a safe return path for the electrosurgical current: The doctor will then attach the single-use, disposable loop electrode to the generator handpiece. Disposables are used to eliminate the possibility of cross-contamination. The cervix will be prepared with acetic acid and iodine solutions so that the doctor can more easily see the extent of the lesion. The doctor will then inject a local anesthetic into the cervix. The electrosurgical generator will be activated and the wire loop will be passed through the surface of the cervix. Depending on the lesion, the excision may take as little as five to ten seconds. Once the lesion has been removed, the doctor will dispose of the loop electrode and use a ball electrode to stop any bleeding that occurs. A topical solution may also be used to prevent bleeding. You should be able to leave the office soon after the procedure. After the procedure, your doctor will send the excised specimen to the pathologist, where it will be examined to verify that the CIN lesion has been completely removed and properly classified.
As with any surgical procedure, some complications may occur following the LEEP procedure. You may experience some pain, discomfort, or bleeding, but these complications are typically mild. If bleeding is more than experienced in a typical period or if significant pain persists, you should notify your doctor.
Your doctor will give you instructions that you should follow for the three week period immediately following the procedure. These instructions may include:
Watch for any heavy vaginal discharge, strong odor, or heavy bleeding. Call your doctor if any of these complications arise.
Finally, your doctor will request that you return for follow-up Pap smears or colposcopy. This will be necessary to ensure that CIN has been completely removed from your cervix and has not recurred.
If you have any questions, call your doctor.