#leep procedure

I’ve gotten a lot of PMs and asks lately about my text post about being diagnosed with (and later treated for) HPV. The post was from 2014, and I’ve seen an uptick of PMs about it lately, so I’d like to address some things/provide an update/re-extend an invite to anyone searching for answers/a shoulder.

After the LEEP procedure, I went in every six months to have a colposcopy for either a year or two. I went through a tremendous amount of self-reflection and tried my best to not blame myself or feel any negative feelings about my sex life. It didn’t really work, and I pretty much swore off sex for about six months despite my doctor telling me it wasn’t necessary. That was a long time for me. Luckily, the LEEP procedure was successful. Now, 3.5 years later, every one of my pap smears have come back normal. Though I’ll have HPV for the rest of my life, it’s non-transmittable and won’t develop into cervical cancer as long as I take care of myself. I’m not being affected in any way by the diagnosis any more, unless you count medical students in my gynecology office commenting on the strange look of my post-surgery cervix during pap smears. If you have HPV, it might feel like the end of the world. It felt like it for me. But it’s not.

In the time that I was not sexually active, I met someone. We’ve been together more than three years now and my diagnosis (which he knows about and was told about before we had a sexual relationship) hasn’t affected the relationship at all.

The moral of the story: A diagnosis of an incurable disease doesn’t mean the end of your sexual life, and it will get better. Though HPV is one of the most common disease, and most people’s bodies take care of it on their own without medical/surgical intervention, the feelings you’re feeling aren’t invalid just because it’s not “as bad” as any other. Get the HPV vaccine, get regular pap smears, enjoy your sex life. If you’d like to PM me, I’m not a medical professional, but I’m happy to talk you through anything or answer any questions you have.

Everything You Should Know About the Leep Procedure

There are a lot of people with cervical scars, and vey little discussion about it, so I don't have hard and fast answers for you.  However I can talk from my experience and the very few studies that I found that actually respond to this question.

First, when might a cervical tear happen?

With a very fast birth in which the cervix isn't able to dilate as quickly as the contractions are pressing the fetus down.

During operative deliveries such as vacuum or forceps assisted vaginal deliveries

If the cervix swells from pushing before it is fully dilated, the stiffened tissue can tear

If a cervical cerclage has been used to keep the cervix closed during the pregnancy (stitches used to hold the cervix closed)

What happens next?

The cervix is repaired with stitches, often under general anesthesia or an epidural block.  If it isn't repaired, patients can lose significant amounts of blood.  Occasionally a laceration might happen without bleeding and without anyone identifying the laceration.  In that case it can heal on its own, though the healing is slow.  Click here for a NSFW photo of a healing/healed cervix with a laceration and read the story.  The repair or self-healing leaves the cervix with scar tissue that may or may not affect future births.

Who else has scar tissue on their cervix?

People who've had a colposcopy with biopsy, removing a small piece of tissue from their cervix to assess for pre-cancerous cells.

People who've had cryotherapy or a LEEP procedure to remove cancerous or pre-cancerous cells and tissue from their cervix.

Very rare instances in which the tools used for an abortion scuff the inside canal of the cervix, causing some small abrasions.

Am I likely to have a second cervical laceration after I had one with my first birth?

I can't say for sure, but I think not.  It looks like all the research that has been done so far has shown that you're not likely to have a repeat laceration.  Tearing once does not increase the likelihood of tearing again in that spot or others.  It's most likely that the mode of birth will indicate whether or not you tear.

So what's the problem?

People with scar tissue can have two opposite problems during pregnancy.  If a big chunk of the cervix was removed during something like a LEEP procedure, the cervix is less strong.  The weight of the baby and the amniotic fluid and the placenta and the huge uterus pressing down on the cervix can cause it to open prematurely, risking the integrity of the pregnancy.  In this case people might need a cervical cerclage (stitches to hold the cervix closed during pregnancy) which we already learned increases the risk for a laceration.

The other consideration is that once labor occurs, the scar tissue might stop the cervix from dilating appropriately.  In this situation, people might be able to dilate to a certain degree and then stop.  They might be told that they need a cesarean section for failure to progress.  Some midwives say that they are now routinely assessing patients for cervical scar tissue so that in the case that this situation occurs, they're able to figure out where the scarring is and massage it during labor until the scar tissue breaks up and allows the cervix to continue dilating.  I haven't seen this, and I could only imagine that is is very uncomfortable, but I keep it in the back of my mind in case I experience this situation. 

So no, I don't think that the history of a cervical laceration makes your pregnancy high risk.  You'll have to talk to your midwives to see if they're comfortable having you deliver at home, but I don't see it being a major issue.