A LEEP, short for loop electrosurgical excision procedure, is a quick outpatient treatment that removes abnormal cells from the cervix using a thin, heated wire loop. It’s one of the most common ways to treat precancerous cervical changes before they have a chance to become cancer, and it’s successful in more than 95% of cases.
Why a LEEP Is Recommended
Most people learn about LEEP after an abnormal Pap smear, a colposcopy, or a positive HPV test. But an abnormal result alone doesn’t automatically mean you need one. The procedure is typically recommended when a cervical biopsy confirms moderate to severe precancerous changes, classified as CIN 2 or CIN 3. These are cells that look significantly abnormal under a microscope and carry a real risk of progressing to cervical cancer if left untreated.
Your doctor might also recommend LEEP if:
- You’ve tested positive for a high-risk HPV strain, particularly HPV 16, alongside high-grade abnormal cells on a Pap smear
- Abnormal cells have persisted after a previous treatment like cryotherapy (freezing) or laser therapy
- A type of abnormality called adenocarcinoma in situ is found, which affects glandular cells deeper in the cervical canal
For milder changes classified as CIN 1, current guidelines from the American College of Obstetricians and Gynecologists recommend monitoring rather than treatment, since these often resolve on their own. In certain high-risk situations, such as when a patient 25 or older has never been screened and shows high-grade cell changes, doctors may proceed with treatment even before a confirmatory biopsy. This “expedited treatment” approach is recommended when the estimated risk of having CIN 3 or worse is 60% or higher.
What Happens During the Procedure
LEEP is performed in a doctor’s office or clinic, not an operating room. You lie on an exam table in the same position as a Pap smear, and a speculum is inserted to hold the vagina open. The doctor applies a local anesthetic to numb the cervix, which you may feel as a brief pinch or mild cramping. Some clinics also offer a mild sedative beforehand if you’re anxious.
Once the area is numb, the doctor uses a small wire loop that carries a low-voltage electrical current. The loop shaves off a thin layer of tissue from the surface of the cervix, precisely removing the area where abnormal cells are growing. The electrical current simultaneously seals blood vessels as it cuts, which helps limit bleeding. A chemical solution is often applied afterward to further prevent bleeding. The entire procedure typically takes around 10 to 20 minutes.
The removed tissue is sent to a lab, which is one of LEEP’s key advantages over treatments like cryotherapy. Because the tissue is preserved rather than destroyed, a pathologist can examine the edges of the sample to confirm that all the abnormal cells were captured. This gives your doctor important information about whether the treatment was complete.
What Recovery Looks Like
Most people go home the same day and return to normal activities within 48 hours, though you should avoid strenuous exercise for at least a week. Mild cramping, similar to period cramps, is common in the first day or two. You’ll likely notice a watery or brownish discharge for several weeks as the cervix heals. This is normal and comes partly from the chemical solution applied during the procedure.
While your cervix heals over the following weeks, you’ll need to avoid placing anything in the vagina. That means no tampons, no douches, and no sexual intercourse for at least four weeks. These restrictions protect the healing tissue from irritation and infection.
Possible Complications
LEEP is considered a safe, low-risk procedure, but it does carry some potential side effects. The most common complication is bleeding. Reported rates vary widely in medical literature, from less than 1% to higher numbers depending on how bleeding is defined and measured. Most post-procedure bleeding is light and resolves on its own, but occasionally it requires medical attention. Signs to watch for include soaking through a pad in an hour, passing large clots, or bleeding that doesn’t taper off after the first week.
Infection is possible but uncommon. A fever, foul-smelling discharge, or worsening pelvic pain in the days after the procedure could signal an infection that needs treatment.
Cervical stenosis, a narrowing of the cervical opening from scar tissue, is a rare but recognized long-term risk. This can sometimes cause painful periods or make future cervical exams more difficult.
LEEP and Future Pregnancies
If you’re planning to have children, it’s reasonable to ask how LEEP might affect pregnancy. Because the procedure removes a small amount of cervical tissue, there is a slightly increased risk of preterm birth or cervical insufficiency (when the cervix opens too early during pregnancy) in future pregnancies. The risk is generally proportional to how much tissue was removed. A single LEEP that removes a small amount of tissue carries a lower risk than repeated procedures or one that removes a larger cone of tissue.
For most people, one LEEP does not prevent a healthy, full-term pregnancy. If you do become pregnant after having a LEEP, let your prenatal care provider know so they can monitor your cervical length during pregnancy if needed.
Follow-Up After LEEP
Treatment is successful in more than 95 out of every 100 people, according to Cancer Research UK, meaning the abnormal cells are fully removed and don’t return. But follow-up is essential. You’ll need surveillance testing, usually a combination of HPV testing and Pap smears, at regular intervals after the procedure. Most guidelines recommend the first follow-up at about 12 months.
If abnormal cells do come back, additional treatment is possible. This might mean a repeat LEEP or, in some cases, a different excisional procedure. The high success rate means most people need only one treatment, but ongoing screening ensures that any recurrence is caught early while it’s still easy to manage.