— Gina, California HPV (human papillomavirus) is a virus that is spread through sexual contact. The virus invades the cells of the vagina and cervix. Most women clear the virus naturally without any special form of treatment, because the infected cells are shed from the cervix and vagina. However, in some women the virus is not cleared — it persists in some of the cells of the cervix. This persistence of HPV causes changes in the appearance of the cervical cells when they are viewed under a microscope and can cause cervical cancer. There is no cure for the virus or treatment to eliminate it from your system once you have been infected with HPV. The HPV vaccine that was recently approved by the FDA prevents an infection in the future and is for women who have never been infected. It usually needs to be given before a person becomes sexually active. LEEP (loop electrosurgical excision procedure), which you are considering, gets rid of abnormal cells that are caused by HPV, but it doesn’t actually rid you of the HPV infection. Your physician would recommend a LEEP if your situation went something like this: You were infected with HPV through sexual activity, and the HPV persisted and caused some abnormal changes in the cells of your cervix. These abnormal cells were then detected on your Pap smear. You probably then had a colposcopy (a special close-up examination of your cervix) and a biopsy of your cervix. The biopsy showed abnormal cells that were suggestive of cervical cancer or showed cervical cancer cells that did not appear to invade the deeper tissues of the cervix (cervical intraepithelial neoplasia, or CIN). Now your doctor must get rid of all the abnormal cells, if possible, and so has recommended a LEEP. The tissue specimen that is removed with the LEEP will be looked at by a pathologist to see if cervical cancer cells are invading your cervical tissue. Regarding the surgery itself, LEEP is an outpatient procedure with a low risk of complications and generally well-tolerated by patients. It does carry a small risk that the cervix will be scarred over (cervical stenosis), as well as the risk of bleeding, infection, swelling of the cervix after the procedure, and post-procedure pain. The LEEP also carries a very small risk of making the cervix “incompetent” during pregnancy — meaning that the cervix does not stay closed tightly enough during the pregnancy. It is therefore not recommended during pregnancy and is generally done following a menstrual period. Finally, regarding your question about the risk of reinfection with HPV, if you and your partner are both monogamous, and you were already infected with HPV from him, you are not likely to be reinfected. If you or your partner have sexual contact with other people, though, then it is possible for you to be infected with other types (or strains) of HPV that differ from the one that you already have. Q2. I’m 19 years old and found out I have precancerous cells on my cervix, and my doctor says that I need to undergo a LEEP. I don’t know that much about the procedure — does it have any side effects? What if I want to have another baby? — Stacey, Idaho Generally, a LEEP (loop electrosurgical excision procedure) is recommended for women who have had a Pap smear that showed abnormal, potentially precancerous cells. Following such an abnormal Pap smear, a colposcopy (a special close-up examination of your cervix) and a cervical biopsy are often performed. If the biopsy shows abnormal cells that we suspect may be cervical cancer, or if it shows cancer cells that do not appear to invade the deeper tissues of the cervix (a condition known as cervical intraepithelial neoplasia, or CIN), then an additional procedure, such as a LEEP, is needed to get rid of all the abnormal cells if possible. The tissue specimen that is removed from the cervix with the LEEP will be examined by a pathologist to see if there is evidence of cervical cancer cells, and if so, to see if any of the cancer cells are invading the deeper cervical tissue. If there is evidence of true cervical cancer with invasion into the deeper tissue, additional treatments may be needed after the LEEP. A LEEP is an outpatient procedure, meaning it is performed in your doctor’s office rather than in a hospital. It is generally well tolerated by women who are otherwise in reasonably good health. There is a small risk of scarring of the cervix (cervical stenosis), bleeding, infection, swelling of the cervix after the procedure, and postprocedure pain. The LEEP also carries a very small risk of making the cervix “incompetent” during pregnancy — meaning the cervix does not stay closed tightly enough during the pregnancy. Even in the rare cases when this happens, there are procedures to help keep the cervix closed in order to support a pregnancy. Generally, the LEEP will be done following a menstrual period. Undergoing a LEEP is not recommended during pregnancy. Learn more in the Everyday Health Cervical Cancer Center.
