LEEP Alternatives & Non-Surgical Treatment for Cervical Dysplasia
Many women find us after being told they “need a LEEP” and walking out of that visit feeling scared, rushed, or unheard.
If that is you, take a breath. You are not alone, and you may have more options than you were told.
At Hitchcock Family Medicine in Hixson / Chattanooga, we focus on
evidence-based, non-surgical alternatives to LEEP, including
topical imiquimod, for carefully selected cases of cervical dysplasia. Our goal is to help you feel
heard, supported, and fully informed, so you can make the decision that feels right for your body and your life.
What Is Cervical Dysplasia?
Cervical dysplasia means that some of the cells on the surface of your cervix look abnormal under the microscope. In most cases, this is caused by a persistent infection with a high-risk type of human papillomavirus (HPV).
These changes are often graded as:
• CIN 1 – mild changes
• CIN 2 – moderate changes
• CIN 3 – more significant changes
Many women are surprised to learn that:
• Not all CIN 2 or CIN 3 automatically require a LEEP.
• A significant portion of CIN 2 can regress with careful observation, especially in younger women (PubMed link). 
Why So Many Women Are Told They Need a LEEP
A LEEP (Loop Electrosurgical Excision Procedure) uses a thin, electrically heated wire loop to remove a small part of the cervix that contains abnormal cells. It is a common and often effective treatment.
However, many women tell us:
• “My doctor did not explain any alternatives.”
• “I felt pressured to schedule the LEEP right away.”
• “No one talked about how it might affect sex or pregnancy.”
• “I left more frightened than reassured.”
Your concerns are valid. Research shows that women and clinicians often have different narratives about LEEP outcomes. In one qualitative interview study, women described more emotional distress and sexual changes than their providers appreciated, pointing to “misaligned narratives” around LEEP and its impact on their lives (PubMed link)
When a LEEP May Be Necessary – And When It May Not Be
There are situations where an excisional procedure like LEEP (or cone biopsy) is appropriate, such as:
• Suspicion for early invasive cancer
• Worsening abnormalities despite careful follow-up
• Certain high-risk situations where guidelines strongly favor excision
But in many other cases, especially:
• CIN 1
• CIN 2-3 in younger or otherwise low-risk women
• Borderline or discordant biopsy results
it can be reasonable to consider observation or non-surgical treatment, as long as you have close follow-up with someone experienced in dysplasia care. Several systematic reviews and cohort studies confirm that CIN 2 often has a high spontaneous regression rate, particularly in younger women. (Examples: PubMed links and Pubmed link are good starting points.) 
Our job is to help you understand where your specific case fits on that spectrum and what your real choices are.
LEEP, Pregnancy, and Future Fertility
One of the most common fears we hear is:
“Will this procedure affect my ability to carry a pregnancy?”
The science on LEEP and preterm birth is nuanced. Some larger meta-analyses have found that excisional procedures on the cervix as a group are associated with an increased risk of preterm birth and related complications, especially as more tissue is removed (PubMed link and Pubmed link ). 
Other analyses suggest that the risk is lower or may be confounded by shared risk factors, but overall, most experts agree that:
• Any excisional procedure should remove the minimum tissue necessary.
• For women who strongly desire future fertility, it is reasonable to explore conservative options when they are medically safe.
We will talk honestly with you about your personal risk profile and your reproductive goals so that you can make a decision that balances cancer prevention and fertility preservation.
Emotional, Sexual, and Quality-of-Life Concerns After LEEP
Many women describe not only physical recovery after LEEP, but also:
• Anxiety about recurrence or cancer
• Changes in sexual comfort or desire
• Feelings of being “damaged” or “not the same”
• Regret about feeling rushed into the procedure
A 2023 interview study in The Journal of Sexual Medicine highlighted a clear mismatch between how patients and providers think about LEEP. Women reported more distress and more changes in sexual function than their clinicians assumed, and the authors called for better counseling and more open discussion before and after treatment (PubMed link). 
If you have already had a LEEP and feel confused, dismissed, or upset, you are welcome here as well. We can help with follow-up, symptom evaluation, and simply making sense of what happened.
A Non-Surgical Option: Topical Imiquimod
For many women who wish to avoid excisional surgery when it is safe to do so, we offer topical imiquimod as an alternative.
What is imiquimod?
Imiquimod is an immune-modulating cream that has been used for years on the skin and external genital area. When used vaginally and on the cervix in carefully selected patients, it can stimulate your own immune system to attack HPV-infected and dysplastic cells.
Benefits of imiquimod as a LEEP alternative
In appropriate patients, potential advantages include:
• Non-surgical: no cutting or excision of cervical tissue
• Immune-based: aims at both dysplasia and the underlying HPV infection
• Helps preserve the cervix: no removal of tissue that might affect cervical length
• Lower risk of bleeding or infection compared with excisional surgery
• Home-based treatment: Can be self-applied at home under physician guidance
Several studies, including randomized trials and a meta-analysis, support the use of imiquimod in high-grade CIN:
• A 2024 systematic review and meta-analysis found a pooled regression rate of about 61% for CIN 2–3 with topical imiquimod, with HPV clearance in many patients (PubMed link). 
• Earlier clinical trials in Obstetrics & Gynecology showed that topical imiquimod was a feasible, well-tolerated treatment for CIN 2–3, allowing many women to avoid excisional surgery (PubMed link ). 
How treatment works in our clinic
While details are individualized, a typical course might look like this:
1. Comprehensive evaluation
• Detailed history, review of prior Pap/biopsy results, and colposcopy.
2. Confirming your diagnosis
• Targeted biopsies if needed to confirm CIN grade and rule out invasive disease.
3. Shared decision-making
• We discuss all reasonable options, including LEEP, observation, and imiquimod.
4. Treatment phase
• Imiquimod cream is applied intravaginally on a regular schedule for several weeks, with guidance on comfort and side effect management.
5. Follow-up colposcopy
• We reassess the cervix with repeat colposcopy and, if needed, biopsies to document regression or resolution.
If at any point your findings become more concerning, we revisit whether an excisional procedure is now the safer choice. The goal is safety first, surgery only when clearly needed.
Pricing and What to Expect
We believe women deserve simple, transparent, predictable pricing — especially at a moment when you’re already dealing with anxiety, conflicting information, or pressure to make a quick decision. Our model removes financial surprises so you can focus on understanding your diagnosis and getting the right care.
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Initial Consultation — No Charge
Your first visit is completely free.
This visit includes:
• A full review of your Pap results, biopsies, and any prior colposcopy
• A detailed explanation of your risk level and what it means
• A gentle, honest discussion of LEEP, observation, and non-surgical options
• Time to ask every question — without being rushed
There is no cost and no commitment to get answers.
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Standalone Colposcopy (If This Is Your First Abnormal Pap or You’ve Never Had One)
If you had an abnormal Pap and need your very first colposcopy, or your prior provider didn’t perform one, we offer this as a stand-alone service.
Standalone Colposcopy:
• $350 for the procedure
• Approximately $50 per biopsy (billed separately by the lab)
This is ideal for women who:
• Want a second opinion before any treatment decisions
• Have never had a colposcopy
• Want a more gentle, slower, more thorough experience
• Want to avoid being rushed into a LEEP after one Pap result
If you already have recent biopsies or a prior colposcopy, we can often skip repeating it.
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All-Inclusive Dysplasia Treatment Program — $1,200 Total
If imiquimod or conservative management is appropriate for you, the program includes everything you need.
Your $1,200 program includes:
• All follow-up visits
• All re-check colposcopies
• All counseling, monitoring, and care coordination
• Unlimited messaging for questions or side effects
• Imiquimod treatment — included at no cost
• Final reassessment colposcopy after treatment completion
There are:
• No per-visit charges
• No additional office fees
• No pharmacy cost for the medication
• No surprise bills ever
This is truly all-inclusive from start to finish.
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Why We Use a Direct, Cash-Priced Model
We do not bill insurance.
Most women prefer this because it allows for:
• Longer, unhurried visits
• Clearer explanations
• More treatment options
• No insurance denials
• No out-of-network problems
• Transparent, predictable pricing
Our patients come to us because they want time, clarity, and a human approach — and our model allows us to deliver exactly that.
Frequently Asked Questions
Is it always safe to avoid a LEEP?
Not always, but in many cases it can be safe. Decisions depend on your exact biopsy results, colposcopy findings, HPV type, age, and other risk factors. Our approach is to follow current evidence and guidelines, and then personalize the plan to you.
Does everyone qualify for imiquimod?
No. Imiquimod is best suited for carefully selected patients, typically with biopsy-confirmed CIN 2 (and some CIN 3) who have reliable follow-up and no signs of invasive cancer. Part of your initial visit is confirming that it is safe to consider this option.
What does imiquimod feel like?
Most women tolerate treatment well. Some have temporary irritation, discharge, or flu-like symptoms that often improve with dose adjustments or schedule changes. We walk you through what to expect and how to manage it.
Can CIN 2 really go away on its own?
Yes. Multiple cohort studies and reviews have shown that a substantial portion of CIN 2 lesions regress spontaneously, especially in younger women, when monitored closely (for example: https://pubmed.ncbi.nlm.nih.gov/31055567/ and https://pubmed.ncbi.nlm.nih.gov/31055567/). 
This does not mean “ignore it.” It means that for some women, conservative management with close follow-up is a reasonable choice.
Do you see patients from outside Chattanooga?
Yes. Many women travel to see us from across the country. We can often review outside records in advance and then schedule an in-person colposcopy and consultation.
Supporting Research
They are here for transparency and for anyone who wants to see the underlying science:
• Topical imiquimod is effective in reducing cervical intraepithelial neoplasia and promoting HPV clearance (systematic review and meta-analysis).
• Topical imiquimod for CIN 2–3 (randomized or prospective trial, Obstetrics & Gynecology).
• Spontaneous regression of CIN 2, with especially high rates in younger women.
• Adverse obstetric outcomes after local cervical treatment for preinvasive disease (meta-analysis).
• Patient and provider perspectives on LEEP/LLETZ treatment and outcomes: “misaligned narratives” around symptoms and sexual function.
Ready for a Second Opinion on Your LEEP Recommendation?
If your mind keeps looping back to that LEEP recommendation, and you cannot shake the feeling that there must be another way, you deserve a thoughtful, unhurried second opinion.
• We review your results.
• We explain your real level of risk.
• We walk through all reasonable options, including LEEP, observation, and non-surgical treatment.
Tell us what’s going on and we’ll help you understand your options. You don’t have to figure this out alone.
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