If you have previously had an abnormal Pap or tested positive for the human papillomaviruses (HPV), your doctor might have recommended a procedure to help clear the abnormal cells. Several conventional interventions are available to address HPV and cervical changes. These procedures aim to remove abnormal tissue and cells in order to prevent progression into cancer.
An HPV diagnosis can be confusing. Adding a potential surgical procedure into the mix may add to your concern, confusion, and anxiety. We hear you; we would want to know the risks, potential harms, and procedural effectiveness as well. Here, we lay out the pros and cons of LEEP and other common conventional treatments for cervical dysplasia so you can be better informed about your options and what is best for your health.
First, a bit about HPV
HPV is the most common sexually transmitted infection around the world. So common that up to 80 percent of sexually active individuals will contract HPV at some point in their lives. Out of the hundreds of different strains of HPV, around 15 have been identified as high-risk. These high-risk strains are associated with cellular changes on the cervix. If these cell changes persist over time, there is a risk that they may lead to cervical cancer.
If you have contracted HPV, do not worry. Up to 90 percent of individuals that contract an infection will clear it within about two years. In individuals that fail to clear the infection, there is an increased risk of developing persistent cell changes that may progress into cervical cancer.
Cervical cell changes are monitored using Pap testing. Interventions have been developed to address cell changes before they can occur in individuals who have had abnormal Pap tests and persistent high-grade cervical intraepithelial neoplasia (CIN). Depending on your situation, your gynecologist may recommend a LEEP, conization, cryotherapy, or laser.
Here we lay out the pros and cons of each of these procedures.
LEEP- Loop electrosurgical excision procedure
The LEEP is an excision method used to remove abnormal cellular changes from the surface of the cervix. LEEP is typically recommended in cases of CIN2/3 or persistent CIN 1. During the procedure, you will assume a similar position as you would for a regular pelvic exam. A thin wire loop with an electric current will be inserted into the vagina to remove cells from the cervix.
Pros of LEEP
- LEEP can be performed in-office. It is quick and generally painless with local anesthesia. The procedure generally takes only 10 minutes.
- LEEP removes less tissue than other methods, leaving less scarring and changes to the cervix than other methods.
- The tissue removed during the procedure can be used to confirm the degree of cellular changes.
Risks of LEEP
- LEEP can cause cramping and light bleeding during and after the procedure.
- The procedure increases the risk of infection, cervical scarring, and changes in sexual function.
- It is associated with an increased risk of preterm labor and low birth weight. The risk of preterm delivery increases with the depth of LEEP exceeding 10 mm.
Effectiveness of LEEP
- The recurrence rate of CIN 2, 3 after treatment varies depending on one’s age, the severity of the disease, the treatment. The five-year recurrence rate of LEEP is estimated at around 8.1%.
Cold Knife Conization
Cold knife conization is another surgical excision method used to remove abnormal tissue from the cervix using a scalpel or laser knife.
This procedure allows your doctor to further examine the cervical tissue to determine cancerous changes. Conization is used to treat cervical dysplasia and very early cervical cancer. The procedure involves the removal of a cone-shaped portion of the cervix to remove a cervical lesion and the transformation zone. Conization may be used when there are conflicting Pap smear and biopsy findings, there is severe dysplasia, or in the early stages of cervical cancer.
Pros of Conization
- Conization also allows for histologic review of extracted tissue to assess HPV infection and cervical changes.
- The cone biopsy is used to effectively diagnose abnormalities of the cervix and treat the early stages of cervical cancer.
Risks of Conization
- Side effects of cone biopsy include risk of infection, cramping, and bleeding during and after the procedure.
- Conization has a higher hemorrhage rate compared to LEEP.
- The procedure removes more tissue than LEEP and therefore a greater risk of scarring and damage to the cervix.
- Conization is also associated with an increased risk of preterm labor and low birth weight.
Effectiveness of Conization
- Conization has been found to have the lowest recurrence rate compared to other procedures. The five-year risk of recurrence is estimated at around 4%.
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Cryotherapy or Laser
Cryotherapy and laser are ablative methods used to destroy abnormal cervical tissue. Cryotherapy uses a freezing gas or liquid nitrogen to remove precancerous cells on the cervix. With laser surgery, carbon dioxide is used to destroy abnormal cervical cells.
Pros of Cryotherapy or Laser
- The procedure is quick and can be done in-office, usually taking between 10 and 15 minutes.
- The risk of preterm labor is not increased as it is with excision methods.
- Removes less tissue than excision methods.
Risks of Cryotherapy or Laser
- Tissue isn’t available for histologic evaluation, so cells cannot be examined for degree of changes.
- Can cause mild cramping during the procedure.
- The procedure may cause vaginal bleeding and lead to infection.
- Cryosurgery can cause scarring of the cervix, cervical stenosis, which may lead to risks to getting pregnant, staying pregnant, and vaginal delivery.
Effectiveness of Cryotherapy or Laser
- Cryotherapy was to be least effective at reducing cervical cancer long-term. It was found to have the highest risk of recurrence of CIN 2/3 and invasive cancer after treatment compared to other methods.
While each procedure carries some risk, there are benefits to each procedure in reducing rates of cervical dysplasia and cancer. We recommend talking to your doctor about your options and what is best suited for your unique situation. Following any procedure, your doctor will schedule a follow-up Pap smear to monitor cell changes over time.
It is important to remember that while the procedures are effective at removing abnormal cellular tissue, they do not remove or suppress HPV activity. Without suppressing the underlying infection, cellular changes can always return, so it is important to continue to monitor the cervix. This continued HPV activity is why supporting the immune system still plays a pivotal role in addressing HPV and preventing long-term complications of the virus.