What is the treatment for HGSIL (high grade squamous intraepithelial lesions) or moderate or severe dysplasia?
It is important to treat the tissue biopsy results and not the Pap smear. Assuming the biopsy shows moderate or severe dysplasia, the most frequently used treatment right now is the loop electrical excision procedure (LEEP). In this procedure, the cells that are abnormal and usually located at the transformation zone of the cervix are excised.
What is involved in having a LEEP or LLETZ procedure done to the cervix?
The LEEP procedure first starts with a colposcopy. You lie on an exam table with your feet in stirrups like a regular pelvic exam. A special non-conducting vaginal speculum is place in the vagina. The cervix is swabbed or sprayed with acetic acid about the strength of a bottled white vinegar.
A colposcope, which is a low power microscope, is used to look at the areas on the cervix that are affected. Following identification of the area to be excised, a xylocaine filled syringe is used to inject local anesthetic at several different points around the cervix.
The xylocaine may have a small amount of epinephrine to lessen the amount of bleeding from the denuded cervix. Sometimes this epinephrine will cause your heart to beat very fast. Let the doctor know about that.
When the cervix is numb, an electrical wire loop is used to scoop a shallow bowl shaped piece of cervical tissue containing the areas that stain abnormally with the acetic acid. During this excision, some smoke is released from the cervix and a vacuum exhaust is used close to the end of the speculum to clear the smoke so the doctor can see well enough to complete the procedure. The vacuum tends to make a loud noise.
Following this, the doctor may want to look again at the cervix with the colposcope to make sure all of the abnormal tissue was removed.
At this point there is still a small amount of bleeding from the excised surface of the cervix. The doctor may cauterize the bleeding areas or swab on an astringent solution to stop the bleeding. Sometimes this astringent solution causes a grayish discharge for a day or two later.
What are complications of the LEEP procedure?
Bleeding is the main complication of a LEEP procedure. It happens about 4% of the time (2) but serious bleeding requiring prolonged observation, stitches or even blood transfusion are in the range of 1.5% (3).
Infection can occur following LEEP but it seems to occur less than 5% of the time and even less if prophylactic antibiotics are given.