“We treat people, not just problems.”
John L. Pfenninger, M.D.
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In 1991, a new treatment was found to remove precancerous conditions of the cervix, vulva (lips), vagina, and anus. This procedure actually uses radiofrequency waves to remove tissue. The waves are a type of electricity that is similar to the AM radio. It is confusing even for me to understand exactly how it works, but it does! The radio waves actually cause less destruction of tissue than does the electrical current, which was used in the past. This procedure is replacing most operating room and laser surgeries.
As you know, you have an abnormality on your cervix. In the past, many of these were treated with freezing (cryosurgery) or conization (a way of cutting out the abnormality) in the hospital. Many of your friends have probably told you about that. The advantages of the LEEP procedure is that it is very effective for treating advanced lesions or very large lesions on the cervix, and it can be done in the office. The same equipment can also be used to remove growths you can see on the genital area.
When you come in for the LEEP procedure, you will be placed in stirrups, just as you are for a Pap smear. The vaginal speculum will be placed. You will be stained with vinegar and examined with the colposcope (essentially a magnifying glass). Iodine will be placed on the cervix to further help identify the abnormal tissue. The cervix will then be numbed with Xylocaine—just like you receive in the dentist's office. Using a thin wire loop, the doctor will remove the abnormal tissue. You will hear a lot of noise from a vacuum that removes the smoke. Although a half hour is set up for your appointment, the procedure itself only takes 8-10 minutes.
The complications from LEEP are rare. We have done perhaps 600 procedures and only 2 or 3% have significant problems.
·Pain and discomfort. This is minimal. A study in our office showed that on a scale of 1-10 where 10 is severe pain, women only rated the pain a 2. It is not bad at all. What didn’t they like? The speculum in the vagina and the shot to numb the area. You really will not feel much else. Afterwards, there may be slight cramping for 24 hours, but that is minimal. Take (4) 200 mg (total of 800 mg) ibuprofen tabs an hour before coming in and then take (3) tabs four hours later. That may be all you need. Do not take any aspirin products, since that may make you bleed.
·Bleeding. You will have some spotting for 8-10 days. When the “scab” comes off in 10-14 days, you may notice a little more bleeding. If you pass large clots, more than you have with your periods, or are concerned, call us. You may also pass some “black stuff” that looks like tissue but it is the medicine we use to control bleeding. Do not worry about that.
·Infection. This is rare but can happen. You may have a slight discharge. If it lasts over two weeks, call us. Also, if you have a fever or experience severe pain in the lower abdominal area, call.
·Recurrence. We may miss some of the abnormality, or it may come back. Be sure to keep your follow-up appointments.
·Stenosis. This means the opening of the cervix scars shut. We must keep it open in order for you to get Pap smears, to have periods, and to get pregnant. There is no way to know if this happens unless the doctor rechecks you. Keep your appointment in 6 weeks for this exam. If found early, it is easy to place a small probe to open it up.
Take (4) 200 mg ibuprofen (Advil, Nuprin or Motrin, etc.) 1 hour before your appointment to help ease any discomfort. Schedule your appointment anytime after your period but at least 5 days before your next expected period.
The real advantages of LEEP are that it is quick, has a high cure rate with the first treatment, and is much cheaper than laser or operating room procedures. In fact, it has almost replaced all the old procedures completely. Studies show that it does not interfere with getting pregnant or having a baby unless repeat procedures are performed.
After the LEEP is carried out, please follow these instructions:
· Refrain from sex for 2-3 weeks.
· Avoid lifting heavy weights for 3 weeks (limit to less than 20 lbs.).
· A brownish-black vaginal discharge for a few days to two weeks is normal. However, if a malodorous (smelly) discharge develops, use a vaginal douche with (1/2 vinegar and 1/2 water) twice a day for 5 consecutive days. If the odor or discharge persists, please call our office.
· If spotting or bleeding persists longer than two weeks, call the office.
· If you develop bleeding with clots, call the office anytime.
· Return to our office in six weeks for a brief check. In 4, 8, and 12 months, you will need follow-up Pap smears either in our office or your doctor's office. We will let you know.
Remember that, even though you have been treated, you still have an increased lifetime risk of developing cervical, vaginal, and vulvar cancer. You and your partner definitely must refrain from smoking. To prevent spread of the wart virus, all major authorities recommend monogamy—having sex with the same partner for the rest of your life. Although condoms and non-oxynol 9 spermicidal jelly may help prevent the spread of warts, they are not totally protective. Even after the three follow up Pap smears mentioned above are normal, you must obtain a Pap smear at least once a year for the rest of your life to screen for cervical cancer. A healthy diet with at least five portions of fruits or vegetables each day is essential. It may also be beneficial to take a good multivitamin with folic acid each day.
Please feel free to ask if you have any further questions or desire further information. Videotapes discussing many of these issues are available for your home viewing.
Copyright, 2011. John L. Pfenninger, M.D. jw02/11