LEEP Procedure

LEEP Procedure - What is LEEP? - Loop Electrosurgical Excision Procedure If your doctor has told you that you need to have a LEEP procedure, it's because your annual Pap smear indicated the presence of abnormal cervical cells, or cervical dysplasia. While the loop electrosurgical excision procedure, or LEEP procedure, may make you wonder if your doctor wants you to jump. The LEEP procedure has nothing to do with jumping. The LEEP procedure is one of several procedures your doctor has available to help diagnose and treat abnormal cervical cells. Other procedures your doctor may want you to have either before or during the LEEP procedure include, a colposcopy and / or a cone biopsy. LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. The generator transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. This causes the abnormal cells to rapidly heat and burst, and separates the tissue as the loop wire moves through the cervix. This technique allows your physician to send the excised tissue to the lab for further evaluation which insures that the lesion was completely removed, as well as allowing for a more accurate assessment of the abnormal area. You may want to ask your doctor if it's OK to take an over-the-counter pain reliever such as ibuprofen before your procedure to help minimize any pain. Never take any drug before any medical procedure without explicitly asking your doctor about it. Always follow your doctors instructions for preparation for the LEEP. What happens during the LEEP procedure? The LEEP procedure takes about 20-30 minutes and is usually performed in your physician's office. In some ways it may seem much like a normal pelvic exam because you will lie on the exam table with your feet in the stirrups. A colposcope will be used to guide your doctor to the abnormal area. Unlike a normal colposcopy, a tube will be attached to the speculum to remove the small amount of smoke caused by the procedure. An electrosurgical dispersive pad will be placed on your thigh. The pad is a gel-covered adhesive electrode which provides a safe return path for the electrosurgical current. A single-use, disposable loop electrode will be attached to the generator hand piece by your physician. Your cervix will be prepared with acetic acid and iodine solutions that enable your physician to more easily see the extent of the abnormal area. Next a local anesthetic will be injected into the cervix; the electroloop will be generated and the wire loop will pass through the surface of your cervix. After the lesion is removed your physician will use a ball electrode to stop any bleeding that occurs; he may also use a topical solution to prevent further bleeding. You can leave your physician's office soon after the procedure. Are there any complications associated with the LEEP? Complications are usually mild but can include: mild pain or discomfort bleeding You should call your physician if you experience bleeding that is heavier than a normal period, or if pain is severe. Other symptoms that should be reported to your physician include any heavy vaginal discharge or strong vaginal odor. After the LEEP you should not: Have sexual intercourse for as long as recommended by your physician Lift heavy objects Use tampons Douche Take tub baths--take showers only to prevent infection It's important for you to remember that having cervical dysplasia does not mean that you have cervical cancer. However, treatment of the abnormal area is imperative to prevent abnormal cervical cells from developing into cervical cancer After the LEEP procedure, make sure to follow your doctor's instructions precisely. Your doctor will tell you when to return for follow up Pap smears, and / or colposcopies. Keeping these follow up appointments is necessary to verify that all of the abnormal cervical tissues have been removed, as well as to make sure that if abnormal cervical cells redevelop they are caught early and treated appropriately. Source: LEEP. ACOG Education Pamphlet AP110. http://www.acog.org/publications/patient_education/bp110.cfm. Accessed 08/24/09.

Genital HPV Infection - Fact Sheet - from CDC.gov

Genital HPV Infection - Fact Sheet What is genital HPV infection? Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it. HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems. What are the signs, symptoms and potential health problems of HPV? Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years. But, sometimes, HPV infections are not cleared and can cause: Genital warts Rarely, warts in the throat -- a condition called recurrent respiratory papillomatosis, or RRP. When this occurs in children it is called juvenile-onset RRP (JORRP). Cervical cancer and other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils). The types of HPV that can cause genital warts are not the same as the types that can cause cancers. There is no way to know which people who get HPV will go on to develop cancer or other health problems. Signs and symptoms of HPV-related problems: Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer. Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer. Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils). For signs and symptoms of these cancers, see www.cancer.gov. RRP is a condition in which warts grow in the throat. These growths can sometimes block the airway, causing a hoarse voice or troubled breathing. How do people get HPV? HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms. A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV. Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop juvenile-onset recurrent respiratory papillomatosis (JORRP). How does HPV cause genital warts and cancer? HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV. How common are HPV and related diseases? HPV (the virus). Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives. Genital warts. About 1% of sexually active adults in the U.S. have genital warts at any one time. Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated. Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about: 1,500 women who get HPV-associated vulvar cancer 500 women who get HPV-associated vaginal cancer 400 men who get HPV-associated penile cancer 2,700 women and 1,500 men who get HPV-associated anal cancer 1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may also be related to tobacco and alcohol use.] Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS). RRP is very rare. It is estimated that less than 2,000 children get juvenile-onset RRP every year in the U.S. How can people prevent HPV? There are several ways that people can lower their chances of getting HPV: Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given at 11 or 12 years of age. Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Gardasil has also been shown to protect against anal, vaginal and vulvar cancers. Either vaccine is recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls beginning at 9 years of age. It is recommended to get the same vaccine brand for all three doses, whenever possible. Boys and men: One available vaccine (Gardasil) protects males against most genital warts and anal cancers. This vaccine is available for boys and men, 9 through 26 years of age. For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV. People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity. How can people prevent HPV-related diseases? There are ways to prevent the possible health effects of HPV, including the two most common problems: genital warts and cervical cancer. Preventing genital warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females (see above). Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers (see above). Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine protects against most, but not all, cervical cancers. Preventing Anal Cancers: A vaccine (Gardasil) is available to protect against most anal cancers in males and females. Screening for anal cancer is not routinely recommended because more information is still needed to find out if screening and follow-up interventions prevent these cancers. However, some experts recommend yearly anal Pap tests to screen for anal cancer in gay and bisexual men and in HIV-positive persons. This is because anal cancer is more common in those populations. Preventing Penile Cancers: There is no approved screening test to find early signs of penile cancer. Preventing Oropharyngeal Cancers: There is no approved test to find early signs of oropharyngeal cancer[see www.cancer.org] Preventing RRP: Cesarean delivery is not recommended for women with genital warts to prevent juvenile-onset RRP (JORRP) in their babies. This is because it is not clear that cesarean delivery prevents JORRP in infants and children. Is there a test for HPV? The HPV tests on the market are only used to help screen women at certain ages and with certain Pap test findings, for cervical cancer. There is no general test for men or women to check one’s overall "HPV status," nor is there an approved HPV test to find HPV on the genitals or in the mouth or throat. Is there a treatment for HPV or related diseases? There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause: Visible genital warts can be removed by the patient him or herself with prescribed medications. They can also be treated by a health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another. Cervical cancer is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. [see www.cancer.org] Other HPV-related cancers are also more treatable when diagnosed and treated early. [see www.cancer.org] RRP can be treated with surgery or medicines. It can sometimes take many treatments or surgeries over a period of years.

8 Ways to Boost Your Fertility- from WebMD

8 Ways to Boost Your Fertility Trying to get pregnant? Pay attention to simple things -- diet, timing of sex, even your lubricant -- and you may conceive faster. Reviewed by Louise Chang, MD If you're like most couples who are trying to conceive, you want to get pregnant sooner rather than later. Having intercourse as close as possible to ovulation can definitely help. But fertility experts say there are other ways men and women can boost their fertility. These simple measures can increase the chances that next month will be the month you'll squeal: "We're pregnant!" Read on for the best suggestions culled from fertility specialists who often recommend these measures before turning to assisted reproduction. 1. Her Fertility Booster: Weight Control Being underweight or overweight can delay the time it takes a woman to conceive, research suggests. Preconception weight is often an overlooked factor in fertility, says William Gibbons, MD, director of the division of reproductive endocrinology and infertility at Baylor College of Medicine in Houston and president-elect of the American Society for Reproductive Medicine. But research suggests keeping a healthy weight can help with conception. "I am not sure women think about it as an issue for their fertility," he says. In one study, researchers evaluated the body mass index (BMI) of 2,112 pregnant women. A BMI of 18.5-24.9 is considered normal weight, 25-29.9 is overweight, and 30 or higher is obese. Women in the study who had a pre-pregnancy BMI of 25-39 had a twofold increase in the time it took to get pregnant. A lower BMI is even worse, the researchers found. Having a BMI below 19 increased the time to conception fourfold. The study was published in Fertility and Sterility in 2004. Gibbons tells women to stay at a healthy weight when trying to conceive. 2. His Fertility Booster: Protect Those Sperm Over the years, researchers have investigated whether everyday exposures -- to such things as tight underwear, heated car seats, laptop computers, or cell phones -- may impair male fertility. The idea that changing to looser underwear -- boxers instead of briefs -- will boost fertility by keeping genital temperatures down is now somewhat of an old wives' tale, says Dale McClure, MD, president of the American Society for Reproductive Medicine. He is also a clinical professor of urology at the University of Washington School of Medicine in Seattle. Although earlier studies seemed to point to boxers as the better choice for preserving fertility, McClure says, ''some of the more scientific data in the past few years didn't show a major difference.'' What about exposing the testicles to other sources of heat? The American Society for Reproductive Medicine says controlling temperature doesn't play much of role in boosting fertility. But some doctors, including McClure, do recommend staying away from certain sources of heat. Sitting in a hot tub day after day, even if a man has no known fertility problems, should be avoided, McClure says. Page 2 of 4 Trying to get pregnant? Pay attention to simple things -- diet, timing of sex, even your lubricant -- and you may conceive faster. (continued) 2. His Fertility Booster: Protect Those Sperm continued... In a study published in the International Brazilian Journal of Urology, researchers found that repeated exposure to high water temperatures through hot tubs or hot baths did have an adverse effect on men's fertility. Other exposures under investigation by researchers have yet to prove a link. For instance, in a study published in Human Reproduction, researchers found that scrotal temperatures went up in laptop users who used the computer on their laps, and warned that long-term exposures to high scrotal temperatures may harm sperm. Even though there isn't enough data to prove the link, McClure says he still wouldn't recommend that a man who wants to be a father keep his laptop on his lap for extended periods of time. In another study, Cleveland Clinic researchers collected sperm samples and found that those samples exposed to the radiofrequency electromagnetic waves from cell phones for one hour were adversely affected compared to samples not exposed. In a report published in Fertility and Sterility, the researchers conclude: ''We speculate that keeping the cell phone in a trouser pocket in talk mode may negatively affect spermatozoa and impair male fertility." Despite that finding from respected researchers at a well-regarded institution, McClure says he is "more concerned about hot tubbing." 3. Her Fertility Booster: Watch the Beverages Drinking too much coffee or too much alcohol can impair a woman's fertility, the American Society for Reproductive Medicine says. Experts say that more than five cups of coffee a day or the equivalent, about 500 milligrams of caffeine, are associated with lower fertility. In another recent study, the researchers who looked at body weight also looked at caffeine and tea intake. They found that drinking more than six cups a day had an adverse effect on fertility. But don't give up your daily cup of coffee just yet. Moderate caffeine consumption, says Gibbons, seems to be OK. According to the American Society for Reproductive Medicine, one or two cups a day is acceptable. His advice for women who are coffee or soda drinkers: "Stay under 200 to 250 milligrams of caffeine a day." The studies on alcohol intake and women's fertility have produced mixed findings. But Swedish researchers reporting in Fertility and Sterility have found that women who drank two alcoholic beverages a day decreased their fertility by nearly 60%. Once again, moderation is key, say experts. Although those higher levels of alcohol, such as two drinks or more a day, should be avoided when trying to get pregnant, "there is no evidence to indicate that more moderate alcohol consumption adversely affects fertility," according to the American Society for Reproductive Medicine. And, of course, once you find out you are pregnant, you'll want to cut out the alcohol completely because drinking can increase the risk of birth defects. Page 3 of 4 Trying to get pregnant? Pay attention to simple things -- diet, timing of sex, even your lubricant -- and you may conceive faster. (continued) Smoking cigarettes can impair both a woman and a man's fertility, research suggests. Researchers from Portugal reviewed the literature on cigarette smoking and fertility. They found that it affects how receptive the uterus is to the egg. In men, smoking can reduce sperm production and damage DNA. The study is published in Current Opinion in Obstetrics and Gynecology. For women, giving up smoking before pregnancy is wise, experts suggest, because smoking while pregnant has been shown to boost the risk of miscarriage. Taking advantage of what doctors call the "fertile window" can boost your chances of pregnancy. It's best defined, according to the American Society for Reproductive Medicine, ''as the six-day interval ending on the day of ovulation." And pregnancy is most likely to occur with intercourse within the three days before the day of ovulation. Patients often wait until the day of ovulation or later to have intercourse, says Richard Paulson, MD, chief of the division of reproductive endocrinology and infertility at the University of Southern California Keck School of Medicine, Los Angeles, and a professor of obstetrics and gynecology there. He tells them: "Err on the early side." He also advises keeping close track of ovulation -- either by the calendar method, figuring ovulation occurs about 14 days before the menstrual period is due, or by using an ovulation predictor kit, widely sold online and in drugstores. Delaying lovemaking -- or as some couples say, ''saving up'' -- isn't going to boost the chances of pregnancy, McClure tells couples who ask about this approach. "After about a week, the [sperm] count goes up a bit, but the motility decreases," he says. Not having sex for more than five days may affect sperm counts adversely, according to the American Society for Reproductive Medicine. But intervals as short as two days don't harm sperm density, it says. Although daily intercourse produced the highest pregnancy rate in one study, it may pose too much stress on the couple, according to the society. And every-other-day sex, in the same study, produced nearly as good a pregnancy rate. Page 4 of 4 Trying to get pregnant? Pay attention to simple things -- diet, timing of sex, even your lubricant -- and you may conceive faster. (continued) With more frequent intercourse, couples may turn more to vaginal lubricants. That's OK, doctors concur, if the lubes are picked wisely. According to the American Society for Reproductive Medicine, some lubricants can actually decrease fertility. That's because some have spermicides. What to use? "Canola oil," says Gibbons. "Even peanut oil is good," says McClure. It's crucial, he says, to avoid lubricant with spermicidal agents. Impromptu household lubes may not be good either, he says. "I had a patient yesterday with a great [sperm] count and no motility [swimming ability]," McClure says. When he asked a few more questions, he got the root of the problem. "He was using soap for a lubricant." So he informed the patient, "Soap killed the sperm." You also want to avoid commercially available water-based lubricants. According to the American Society for Reproductive Medicine, commercially available water-based lubricants, such as Astroglide, KY Jelly, and Touch may inhibit sperm motility by 60% to 100% within 60 minutes of incubation. Canola oil, however, did not have the same effect. The studies comparing lubricants have been published over the years in a variety of journals, including Human Reproduction and Fertility and Sterility. Exposures to pesticide, especially agricultural pesticides, may harm both men and women's fertility, the American Society for Reproductive Medicine warns. Exposure to some solvents and toxins -- including those used in printing businesses and dry cleaning establishments -- can adversely affect women's fertility.