Most women experience some transitory pain from the injection of localanaesthetic into the cervix. Severe perioperative bleeding occurs after 2% orless of LEEP procedures. Women should be advised to contact the clinic if theyhave any concerns during the postoperative period.
It is advisable to givewritten post-operative instructions that outline the following points. Fewwomen complain of post-operative pain. If post-operative pain occurs, itusually is similar to cramps; women should be instructed to use oral analgesicssuch as acetaminophen or ibuprofen, if necessary. A blood-tinged, dark brown(from theMonsel’s paste) mucus discharge usually lasts for one or two weeks aftertreatment. Severe and moderate postoperative bleeding occurs in a few women, whoshould be seen promptly.
Healing after LEEP usually takes place within a month.When post-operative bleeding occurs, it usually appears 4-6 days aftertreatment and often from the posterior lip of cervix. This bleeding can usuallybe controlled by fulguration, applying Monsel’s paste, or using a silver nitrateapplicator stick. Rarely, placement of a suture at the bleeding site isnecessary. The risk of post-operative infection is very small and can probablybe reduced even more by delaying surgical treatment until any woman with alikely diagnosis of PID, cervicitis, vaginal trichomoniasis or bacterialvaginosis has been adequately treated and recovered.
If a woman presentspost-operatively with a malodorous discharge, it should be cultured if possibleand empirical treatment prescribed with antibiotics that are effective for PID.In developing countries, it may be preferable to institute routine presumptivetreatment with antibiotics after LEEP (doxycycline 100 mg orally, two times aday, for seven days and metronidazole 400 mg orally, three times a day, forseven days). The squamocolumnar junction is in the endocervical canal at thefollow-up evaluation in approximately 2% of women. This presents a challengefor adequate colposcopic examination and cytological sampling.
Women should bewarned that cervical stenosis, partial or complete, is rarely encountered(probably less than 1%), but is more common in menopausal women.