What are the recommended post-op precautions after a Loop Electrosurgical Excision Procedure (LEEP)?

Post-LEEP Precautions: Recommendations for Recovery

After a Loop Electrosurgical Excision Procedure (LEEP), patients should abstain from sexual intercourse, tampon use, and douching for at least 4 weeks to allow for proper healing and reduce the risk of complications. 1

Immediate Post-Procedure Care

• Apply a pressure dressing for 12-24 hours after the procedure to decrease the risk of bleeding 1
• Keep the patient lying flat for 5 minutes with legs out of stirrups after the procedure to prevent vasovagal reactions 1
• Gradually raise the head of the examination table in increments to prevent orthostatic hypotension 1
• Offer a beverage/snack and heat pad/hot water bottle for comfort 1

Pain Management

• Recommend NSAIDs for post-procedure pain management:
  • Naproxen 440-550 mg every 12 hours, or
  • Ibuprofen 600-800 mg every 6-8 hours, with food, for the first 24 hours post-procedure 1
• Warm packs on the abdomen or back may help reduce cramping pain 1

Expected Post-Procedure Symptoms

• Mild to moderate vaginal discharge for up to 2-3 weeks is normal 2
• Light spotting or bleeding may occur for 1-2 weeks 3
• Mild cramping may occur in the first few days 2

Activity Restrictions

• Avoid strenuous or intense exercise for at least 2 weeks, as it has been associated with increased bleeding 3
• Resume normal daily activities as tolerated, but avoid heavy lifting for 1-2 weeks 1
• Abstain from sexual intercourse for 4 weeks to allow for proper healing 2
• Avoid using tampons or douching for 4 weeks 1

Follow-Up Care

• Schedule a follow-up appointment at 4-6 weeks post-procedure 1
• Patients should be instructed to call their healthcare provider if they experience:
  • Heavy bleeding (soaking through a pad in less than an hour) 4
  • Severe abdominal pain 4
  • Foul-smelling vaginal discharge 4
  • Fever over 100.4°F (38°C) 4

Long-Term Follow-Up

• For patients with CIN 2 or CIN 3 with negative margins, follow-up with cervical cytology at 6 months or HPV DNA testing at 12 months is recommended 1
• For CIN 2 and CIN 3 lesions with positive margins, options include:
  • Cervical cytology at 6 months (an ECC can be considered) 1
  • Reexcision if invasion is suspected 1

Special Considerations

• While LEEP is generally well-tolerated with minimal impact on sexual function, some patients may experience small decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction in the first few months after the procedure 5
• The overall complication rate for LEEP is approximately 5-16%, with bleeding being the most common complication (6-11%) 4, 6
• Patients with a history of cesarean section may have a higher risk of complications and should be monitored more closely 4