More than 13,000 US women are diagnosed with cervical cancer each year. In most cases, cervical cancer can be prevented through vaccination and proper cervical screening.

Despite screening programs, 4,000 US women die from HPV-related cervical cancer each year.

What is the point of a pap smear?

A pap (Papanicolaou) smear is a screening test for cervical cancer. The cervix is the opening of the uterus located at the back of the vagina. During a pap smear, doctors place a device called a speculum into the vagina.

The speculum opens the walls of the vagina allowing visualization of the cervix. Cervical cells are then collected using a small brush. These cells are sent to a lab for analysis.

The cells are processed under a microscope to evaluate for precancerous changes called cervical dysplasia. The goal of pap screening is to detect abnormal cervical changes so we can intervene long before cervical cancer develops.

Do I need an HPV test with my pap?

In addition to analyzing the cervical cells, doctors often perform an HPV test. HPV testing recommendations vary depending on your age. HPV testing is recommended for standard screening in women over 30.

HPV testing is also triggered when an abnormal pap smear is found in women under 30. Cervical dysplasia (precancerous cells of the cervix) are linked to the Human papillomavirus (HPV).

Statistically, 80% of Americans will contract HPV, making it the most common sexually transmitted infection. This means more of us will contract this STI than those who do not. HPV “co-testing” during pap smear helps guide the management steps when an abnormality occurs.

Around 40 of the known 130 known strains of HPV affect the genital tract. In men and women, HPV causes genital warts, and persistent strains can lead to cervical, penile, vaginal, anal, mouth, throat, and neck cancer. Approximately 20,000 women and 12,000 men develop cancer caused by HPV every year in the United States.

Who is at risk for HPV?

Anyone sexually active is at risk. The virus may stay dormant for years. Symptoms may not appear until long after you have sex with someone previously infected. It is rarely possible to know when you first became infected. You can not play the blame game with HPV.

Sexually transmitted HPV types fall into two groups, low risk and high risk.

• Low-risk HPVs mostly cause no disease. However, a few low-risk HPV types can cause warts on or around the genitals, anus, mouth, or throat.
• High-risk HPVs can cause several types of cancer. There are about 14 high-risk HPV types. Two of these, HPV16 and HPV18, are responsible for most HPV-related cancers.

Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, mouth, throat, anus, rectum, penis, vagina, and vulva. 

The HPV vaccine and keeping your pap smears up to date are our best tools to impact cervical disease and HPV.

There is no cure or medication for HPV. The most effective way to protect yourself from HPV infection is to get vaccinated. The HPV vaccine is FDA approved for men and women age 9–45. The Center for Disease Control recommends that the vaccine be given as early as 11 or 12.

HPV vaccination is recommended by the Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunizations Practices (ACIP) to prevent new HPV infections and HPV-associated diseases, including some cancers.

The vaccine is most effective when given before initiating sexual activity. It is still useful for those already sexually active as very few have already been exposed to the nine strains of HPV covered in the vaccine.

The most recent recommendations extended the age from 26 to 45, but insurance coverage for those in this age group is lagging.

Pap smears allow for early detection of disease

When a pap smear comes back abnormal, there is no reason to hit the panic button. The next step is a microscope exam called a colposcopy procedure. A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye.

This office procedure helps determine where on the cervix the abnormal cells are coming from and how severe the abnormality is.

If an area of the cervix appears concerning or precancerous, the doctor can sample the area with a biopsy during the exam.

If the biopsy shows a precancerous lesion, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

A few minutes of discomfort can save your life

Pap smears save lives. Period. No one likes to get this test, but the benefits of early detection and prevention outweigh the risks of avoiding it.

If it is time for you to update you pap smear, it is well worth your time to do it. A pap smear could save your life.

The post Pap smears Aren’t Fun But Can Save Your Life by Preventing Cervical Cancer appeared first on Medika Life.

What is a Loop Electrosurgical Excision Procedure?

LEEP stands for Loop Electrosurgical Excision Procedure. It’s a treatment to prevent cancer after precancerous cells are identified during cervical cancer screening. Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives. 

80% of Americans will contract HPV, making it the most common sexually transmitted infection. Persistent HPV strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives.

A small wire loop is used to remove abnormal cells from your cervix. The thin wire loop is attached to an electrical current to cut away the top layer of cervical cells and remove the effects of HPV. 

HPV effects are detected during a routine paps smears, the first step in cervical cancer prevention. When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a LEEP Procedure performed?

A Loop electro excision procedure can be performed in a variety of settings. Most commonly, Obgyns perform this procedure in the office setting. 

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

Can my family visit me?

Most LEEP procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. If the procedure is done in an hospital or Ambulatory Surgery Center, your family is welcome to stay with you before and after the procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a LEEP procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the availability of office equipment. 

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options. 

In the office setting, anesthesia is provided via a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. For a LEEP procedure, a medication called epinephrine is mixed with the anesthetic to reduce the risk of intraoperative bleeding.

Some gynecologists also recommend oral medication to reduce anxiety.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

When a LEEP procedure is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

If a LEEP is scheduled in a hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room??

For an office-based procedure, your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina. The cervix is cleaned to make the area sterile. 

A paracervical block anesthetic is then gently injected into the cervical tissue. The medication absorbs into the surrounding area to numb the nerves and make the procedure more comfortable. 

The surgeon selects the appropriate sized LEEP wire to match the size and appearance of your cervix. Because a low dose electrical current is used to do the cutting, a grounding pad is placed on the outside of your leg. The doctor will take extra precautions to ensure an adequate and safe view of the cervix. A grounding pad is placed on the outside of your leg.

Once all preoperative safety checks are confirmed, the surgeon will activate the electrical current to pass the wire across the top layer of the cervix. This action removes a small, pancake layer of cervical cells. This specimen is sent to a pathologist for analysis. 

The electrical current is then used to stop any bleeding through a process called cauterization. Often, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days. 

In the hospital setting, things function a little differently. 

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting. 

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure as described above.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. 

A LEEP procedure takes approximately 10–15 minutes of surgical time. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based LEEP procedure, patients may go home after getting dressed as long as you are feeling normal. 

Hospital-based procedures under general anesthesia will follow a different process. 

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

LEEP procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common. 

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time. 

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge. 

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons. 

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks. 

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised. 

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit. 

A follow-up pap smear will be scheduled to confirm all of the abnormal cells have been successfully removed and do not come back. 

Danger Signals to look out for after the procedure

After a LEEP procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What should I pack at home to take with?

Nothing special is required after a LEEP procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

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