Everything you need to know about the LLETZ (LEEP) cervical procedure

A group of women say the LLETZ/LEEP procedure has left them sexually paralysed, in physical and psychological pain, and knocking on the door of the medical establishment with no one answering their questions and concerns. Here, we break down everything you need to know about the cervical cancer prevention surgery.

What is a LLETZ/LEEP procedure?

A large loop excision of the transformation zone uses a low-voltage electrical current to remove abnormal tissues of the cervix. It is a treatment that prevents cervical cancer. LLETZ surgery may be performed after abnormal cells are found during a Pap test, colposcopy, or biopsy.

How is a LLETZ/LEEP performed?

The patient lies on an examining table with her feet elevated in stirrups. A speculum is inserted to open the vaginal walls. Sometimes a special solution, either vinegar (acetic acid) or iodine, is applied to the cervix prior to the procedure because it makes the abnormal areas of tissue easier to identify.

The area is numbed using a local anesthetic (cervical block), or in some cases general anaesthetic is offered. Oral or intravenous medications to control pain may also be given. A low-voltage electrical current is delivered via a thin wire that is passed through tissues to remove the abnormal areas of the cervix. A chemical is applied afterwards to prevent bleeding.

How effective is LLETZ/LEEP?

Further treatment is not typically necessary if all of the abnormal area has been removed, however the precancerous changes may develop again at a later time. There are even some studies that suggest having the procedure makes it more likely that cervical cancer will develop.

Is having a LLETZ/LEEP necessary?

It is the most common procedure used to stop the development of cervical cancer. Women who show signs of abnormal cellular change will more often than not be booked in for a LLETZ/LEEP procedure. However, women do have the choice to refuse treatment even if medical practitioners suggest otherwise. Not all abnormal cells turn into cancer and in some cases will return to normal without intervention.

What are the ‘official’ side-effects issued by medical practitioners?

Most official guidelines describe mild pain, similar to period pain. Light vaginal bleeding and brown, watery vaginal discharge which may last up to four weeks
There is also a small risk of more serious complications such as a cervical infection and a slightly increased risk of premature birth in future pregnancies. Women also say the procedure can cause cervical and vaginal paralysis, sexual dysfunction and emotional trauma.

Are there alternatives?

Abnormal cells in the cervix can also be treated with cryotherapy where the abnormal cells are frozen and destroyed; laser treatment where a laser is used to pinpoint and destroy abnormal cells on the cervix; cold coagulation where a heat source is applied to the cervix to burn away the abnormal cells; and hysterectomy (removal of the womb) which is generally only considered if abnormal cells on the cervix have been found more than once, if they're severely abnormal, or women do not want more children.

However, the most common procedure is the LLETZ and it is unclear whether any of the options provided safeguard against sexual dysfunction and sexual paralysis.

Why do some women and researchers argue the procedure causes sexual dysfunction?

The cervix has three neurological systems - the pelvic, hypogastric, and vagus nerves - and therefore the LLETZ carries the possibility of causing nerve damage and vaginal tissue injury. It is common practice to treat the cervix as insensate - devoid of sensation - since the Kinsey Report’s Sexual Behavior in the Human Female was released in 1953. However, there is mounting evidence that disagrees with this theory, particularly as many women rely on the cervix for healthy orgasmic pleasure.

What is the male equivalence and how is it approached differently?

A comparison can be made between the treatment of prostate cancer in men with cervical cancer in women. Surgery is usually offered as a last-resort treatment for men with signs of prostate cancer because it can cause erectile dysfunction. The side-effects of surgery, including sexual problems, are clearly stated to male patients before. There is also an abundance of nerve-sparing treatments for men to choose from, but there are none offered for the LLETZ procedure. Male sexuality is a very important consideration in universal practice, however there tends to be no mention of the sexual side-effects in the LLETZ/LEEP procedure.

Why is the LLETZ/LEEP being criticised as an example of gender bias in medicine?

Some women feel they have been deprived of choice, of informed and thoroughly-researched options due to a lack of research into the consequences of the procedure. They also say doctors and healthcare providers aren’t even aware that women are suffering in this way, and are just told the side effects are purely psychological. Many question whether being female has obstructed proper research into nerve-sparing treatments.