Published: Sep 10, 2016, edited: Oct 9, 2017 by Dr. Zelmanovich (Gynecologist in NYC), Manhattan Women's Health & Wellness

LEEP (Pap Smear Test Follow-ups)

LEEP procedureGetting back a diagnosis of “abnormal” after a routine exam at your OBGYN can be scary. Fortunately, accurate testing can confirm the possibility of cancer or not. A colposcopy exam and a loop electrocautery excision procedure (LEEP) are consecutive steps your doctor uses in the process of diagnosing and treating abnormal and potentially precancerous cells found on your cervix. It’s not a LEEP vs colposcopy thing; they work together. Usually the process goes as follows:

  1. After your annual pelvic exam, your Pap smear comes back abnormal.
  2. A colposcopy is conducted to look for visible abnormalities on your cervix.
  3. LEEP cone biopsy or other biopsy is done to test the cells and determine if those cells really are cancerous.

Why You Need a Pap Smear

Looking for cervical cancer is the main reason that you have a Pap smear test done on a regular basis. It’s often combined with an HPV test for human papillomavirus. The Pap smear is recommended for all women over the age of 30 and should be done about every three years until you turn 65. You may need to get a Pap smear test more often if you have certain risk factors, such as:

  • HIV or AIDS
  • A weakened immune system
  • A pervious Pap smear in which precancerous cells were found
  • You’ve had cervical cancer in the past
  • You were exposed to diethylstilbestrol (DES) before you were born

DES is a synthetic form of estrogen. This female hormone was prescribed in during the years 1940 through 1971 to many pregnant women.

LEEP vs Cone Biopsy

These are two forms of biopsy can be used following a colposcopy exam to determine if cancerous or precancerous cells exist on your cervix. Once the colposcope has identified the abnormal areas of the vagina, it’s necessary to attain a sample of this tissue for testing.

Both of these procedures have their pros and cons, but the end results are ultimately the same — both allow your doctor to learn the reason for your abnormalities. These biopsies are truly effective, ranging between 85 to 90 percent accurate for diagnosing and treating abnormal cervical cells.

The cone biopsy, uncomfortably referred to as the “cold knife” biopsy, is conducted in an operating room under either local or general anesthesia. Whereas LEEP uses a wire, the cone biopsy uses a scalpel to remove a small cone-shaped piece of tissue for further analysis. Since you’ll be under anesthesia, you won’t feel a thing. Because it’s an outpatient procedure that is performed in a specialized NYC gynecology center, you’ll go home the same day.

LEEP Procedure Pain

As with all forms of biopsy, you should expect a small degree of discomfort after the procedure. Since LEEP uses electricity, though, you’ll experience a sensation of heat rather than the pinching sensation that accompanies other forms of cervical biopsy.

Bleeding after LEEP is usually quite minimal. In very few cases, bleeding may be heavy enough to require further medical treatment. Most everyone only experiences slight spotting. You can expect to return to your normally scheduled menstrual cycles.

LEEP Procedure Pregnancy

The loop electrocautery excision procedure isn’t usually chosen in cases where your doctor believes you have obvious signs of cancer. Neither the LEEP nor the cone biopsy is used if you’re pregnant or exhibiting signs of an active infection.

If you do have had a LEEP or cone biopsy, you’re at a much higher risk for preterm birth. Your risk increases with each biopsy you have, and your chances for preterm labor increases too. The risk level also seems to increase with the depth of the biopsy. Scarring may develop on your cervix, which makes getting an accurate Pap smear in the future much more difficult. If too much scarring occurs, you may have to have another procedure to open or remove the scar tissue.

Sex After LEEP

It’s usually recommended to wait about three weeks before participating in sexual intercourse, or until your doctor gives you the green light. While you may feel better after only a couple days, it’s important to keep in mind that you very recently had a piece of your cervix removed.

You need to allow your body time to heal. Waiting three to four weeks ensures that you’ll be safe as well as comfortable. Having sex can lead to a host of new complications you don’t need, including:

  • Tearing open internal incisions
  • Infection
  • Prolonged bleeding
  • Pain and discomfort

Important Results from Your Tests

Abnormal cells found after a Pap smear test can lead to a range of diagnoses. But it absolutely doesn’t mean that you have cancer. The diagnosis instead depends on the type of cells that were discovered. Further tests can confirm it. Possibilities might include:

  • Squamous intraepithelial lesions indicate that the abnormal cells may be pre-cancerous, meaning they could turn into cancer if not treated appropriately. If the changes your doctor finds are low grade, it’s more than likely that you’re years away from actually having cancer, meaning you can get the source removed before it becomes cancerous. High-grade changes, on the other hand, mean that there’s a great possibility that you have cancer and need to undergo more testing as soon as possible.
  • Adenocarcinoma or squamous cell results mean almost certainly that cancer is present. Adenocarcinoma cells are those having to do with cancer in your glands, while squamous cell cancer is the disease found on the surfaces of your cervix or vagina.
  • A finding of atypical glandular cells just means that the cells that produce mucus are abnormal. That’s why you need the biopsy to tell if they are cancerous or not. Glandular cells grow inside your uterus and at the opening of your cervix.
  • Atypical squamous cells of undetermined significance (ASCUS) aren’t clearly cancerous or precancerous, another very convincing reason to get a biopsy and have them checked out. Squamous cells are those thin, flat cells that naturally grow on the surface of your cervix when it’s healthy. An examination following a diagnosis of ASCUS usually tests for viruses that can lead to cancer, such as some kinds of the human papillomavirus (HPV). If no viruses that tend to be high risk are found, then you don’t have anything to be concerned about.


Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult ob/gyn doctor about your specific condition. Only a trained, experienced board certified gynecologist can determine an accurate diagnosis and proper treatment.

Do you have questions about LEEP (Pap Smear Test Follow-ups)? Would like to schedule an appointment with the best NYC Gynecologist, Dr. Anat Zelmanovich, please contact our office.

Manhattan Women’s Health & Wellness
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Midtown OB/GYN)
51 East 25th Street, Ste 403, New York, NY 10010
(Between Madison Ave & Park Ave)
(212) 533-4575
Manhattan Women’s Health & Wellness
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Upper East Side OB/GYN)
983 Park Ave, Ste 1D, New York, NY 10028
(Between 83th & 84th Street)
(212) 427-8761
Manhattan Women’s Health & Wellness
Dr. Anat Zelmanovich, Gynecologist (Gynecologist NYC, Union Square OB/GYN)
55 W 17th St Ste 104, New York, NY 10011
(Between 5th & 6th Avenue)
(212) 378-9985
The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self diagnoses should not be made based on information obtained online. It is important to consult a best in class gynecologist in Midtown regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or our Gynecology NYC office today and schedule a consultation with a top Midtown OBGYN gynecologist.