Psychosexual Health After Loop Electrosurgical Excision Procedure (LEEP) among women with Cervical Intraepithelial Neoplasia in North Indian tertiary Centre: A Prospective Observational Study

Abstract

PURPOSE- Cervical cancer is a leading cause of cancer death in low and middle-income countries (LMICs). Loop Electrosurgical Excision Procedure (LEEP) is a valuable diagnostic and therapeutic tool for Cervical Intraepithelial Neoplasia Grade 2 or 3 (collectively referred to as CIN2+) lesions on outpatient visits. However, removing a part of the cervix during the procedure might affect a woman’s perception of sexual function This study was planned to assess the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women who are subjected to LEEP as a part of cervical dysplasia management. METHODS- All patients attending OPD at the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India, between October 2020 to March 2021, diagnosed with CIN 2 and CIN 3 lesions and planned for LEEP; were enrolled in our study after taking consent. Women were interviewed regarding their sexual function before the LEEP procedure and after six months while on follow-up with self- structured pre- and post-procedural sexual function questionnaire. RESULTS- 61 sexually active women who underwent LEEP for high-grade CIN2+ lesions were enrolled in the present study. There was significant improvement in pain during vaginal penetration, post coital bleeding, level of anxiety related to sexual life, and overall sexual satisfaction post LEEP procedure. CONCLUSION- The present study concluded that LEEP poses no long-term effect on women's sexuality, with a reduction in dyspareunia and postcoital bleeding, along with improvement in overall sexual function, although small but statistically significant.

The Impact of HPV Diagnosis and the Electrosurgical Excision Procedure (LEEP) on Mental Health and Sexual Functioning: A Systematic Review

“…Depression, anxiety, general quality of life, and sexual function, as well as the effect of therapy on quality of life, mental state, and sexual function were assessed through the mentioned scales. In addition, 18 studies used non-validated questionnaires, surveys, or qualitative face-to-face interviews to assess mental status and quality of sexual life [ 13 , 14 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ].…”

“…The observational studies were classified using the ROBINS-E tool. Fourteen of the fifty-six included studies were rated as ‘low risk of bias’ [ 10 , 13 , 15 , 22 , 24 , 25 , 26 , 29 , 30 , 34 , 36 , 40 , 47 , 48 ], sixteen as ‘some concerns’ [ 8 , 9 , 11 , 14 , 17 , 19 , 32 , 39 , 44 , 49 , 52 , 53 , 54 , 55 , 56 , 67 ], twenty as ‘high risk’ [ 6 , 7 , 16 , 27 , 31 , 33 , 35 , 38 , 41 , 42 , 43 , 45 , 46 , 50 , 51 , 57 , 58 , 59 , 60 , 61 ], and five as ‘very high risk’ [ 62 , 63 , 64 ...…”

“…Seven of these were quantitative studies using validated instruments to assess mental state and sexual function, while three were qualitative studies. Most of these (8/10) studies were of good quality (‘low risk of bias’/‘some concerns’) [ 13 , 14 , 15 , 17 , 24 , 30 , 39 , 55 ], and two were assessed as ‘high risk of bias’ [ 16 , 42 ]. Four studies addressed the issue of mental health after the LEEP procedure [ 15 , 24 , 30 , 62 ], of which only one study found a negative effect of LEEP on anxiety symptoms [ 30 ] (1/4, 25%), while 75% (3/4) did not confirm these findings [ 15 , 24 , 39 ].…”

“…Four studies addressed the issue of mental health after the LEEP procedure [ 15 , 24 , 30 , 62 ], of which only one study found a negative effect of LEEP on anxiety symptoms [ 30 ] (1/4, 25%), while 75% (3/4) did not confirm these findings [ 15 , 24 , 39 ]. In total, six out of 10 studies, or 60% (5/7, 71% of quantitative studies and 1/3, 33% of qualitative studies), did not confirm a negative impact of the LEEP procedure on sexual functions [ 14 , 15 , 16 , 17 , 24 , 39 ], while four studies, or 40% (2/7, 28% of quantitative studies and 2/3, 67% of qualitative studies), found such an association [ 13 , 30 , 42 , 55 ]. Some participants reported that symptoms of dyspareunia and postcoital bleeding, which indirectly affected sexual health, showed significant improvement post-LEEP procedure [ 14 ].…”

“…The study by Inna et al [ 13 ] proved that excisional treatment of cervical lesions was associated with a decrease in overall sexual satisfaction. On the contrary, Gaurav et al noticed a significant improvement in symptoms of dyspareunia and postcoital bleeding after the LEEP procedure [ 14 ]. In turn, three other researchers found no differences in sexual functioning and mental well-being between women treated and not treated with LEEP [ 15 , 16 , 17 ].…”