When Rosie opened a letter and saw the words ‘abnormal cells’ she felt pure panic.
‘I didn’t think I’d be told that way,’ the 38-year-old tells Metro. ‘No one explained what those words actually meant. All I got was a number to make an appointment for a procedure to remove them.’
The letter, which Rosie Dixon received in 2018, was inviting her to undergo a large loop excision of the transformation zone (LLETZ) to remove some pre-cancerous cells discovered in her cervix.
When she made the appointment, she claims there was no room to question the procedure because she was funnelled through an efficient ‘conveyor belt’ system to remove them.
‘I could only ask questions once I was already in the room; there’s no pre-appointment where you can speak to the doctor and explain your fears,’ she remembers. ‘I did ask what are the chances of the cells becoming cancerous and are there any alternative treatments, but they couldn’t answer them. It felt like the doctors were being extremely pushy and that if I didn’t have it done now there was a chance I might not get seen. It was almost as if they were surprised anyone would question the process.’
Rosie says she also felt forced into going ahead because her loved ones were scared by the phrase ‘pre-cancerous cells’ combined with a real sense of urgency. ‘I don’t blame them — the doctors or my loved ones — but it felt like there was no room to make a different choice or at least slow down,’ she explains.
Plus, she adds, there was one side effect that wasn’t discussed with her at all: sexual dysfunction.
‘They only told me about short-term side effects, like bleeding and higher risk of pre-term labour. In their opinion, there were no long-term side effects. Yet, now, after sex, I often experience cramping, and it feels like there’s something wrong inside me. I also have chronic pelvic pain that started after the LLETZ.
‘I made the link by asking myself, when was the last time I felt intact and pain free? And it was before the procedure.’
Every year, pre-cancerous cells are removed from 50,000 cervixes in the UK via a large loop excision of the transformation zone, commonly known as LLETZ.
It’s become a standard procedure typically done under a local anaesthetic, designed to remove cells often caused by high-risk strains of the HPV virus before they develop into cervical cancer, the fourth most common cancer in women globally and 14th in the UK.
‘The procedure uses a small, thin wire with an electric current to burn off the abnormal cells; it’s very quick,’ explains Dr Oluwatobi Adesanya, a GP with a special interest in women’s health. ‘It’s successful for nine out of 10 people who have it. The whole system is an excellent screening programme for cancer because it’s preventative.’
With the NHS aiming to eliminate cervical cancer by 2040, it’s undoubtedly a massive win for women’s health; however, some patients, like Rosie, claim to face long-term side effects that massively impact their sex lives.
Maddie Brown*, 43, had the procedure in 2022.
‘It was a positive experience and went really well; I was given leaflets with lots of information,’ she recalls to Metro. However, over the next year, she noticed a side effect not included in the leaflets.
‘At first, I didn’t notice anything because I was single, but when I started seeing my partner in 2023, I immediatelywas aware of differences in sensation,’ explains the civil servant from Wales.
‘I put it down to being with someone new, but once our relationship became more established I started to question what was happening. I’ve never had a super high sex drive, but I did notice a drop, and I couldn’t orgasm from penetrative sex anymore.
‘Luckily, my clitoris still works, but I didn’t expect something like this to happen and I only made the link after I researched my symptoms and found other women online sharing the same experiences as me.’
Though her partner is always understanding, the impact on Maddie’s confidence is significant.
‘It’s changed what I enjoy,’ she admits. ‘Especially as we’ve managed to find our relationship at this point in our lives, and everything else works so well. I sometimes feel we’ll never have the closeness and intimacy that I really crave.
‘I’m keen not to put people off getting a procedure if that’s what they need, but it’s not really informed consent if you don’t know how it could affect you.’
The LLETZ pathway
The process in the UK starts with a cervical screening test, which women are invited to do every three years under age 49 and every five years between 50 and 64. If the test results indicate the presence of high-risk Human Papillomavirus (HPV), the sample is checked for abnormal cells. When such cells are detected, patients receive a letter in the post recommending that they attend a colposcopy.
At colposcopy, an examination of the cervix is undertaken and biopsies may be taken. A LLETZ procedure may also be performed simultaneously to treat abnormal cells, or this may be done at another appointment.
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Research into the impact of LLETZ on sexual dysfunction is limited, making it difficult to determine precisely how common the problem is. One study published in the Journal of Korean Medicine showed that as many as 65% of women experience some degree of change in sexual sensation after LLETZ, while a 2010 Thai paper found that the procedure is connected to ‘small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction.’
Despite these findings, such side effects do not appear in any literature given to patients before or after the procedure. It also isn’t mentioned on the NHS page about LLETZ. However, the Royal College of Obstetrics and Gynaecology does mention sexual dysfunction in relation to the procedure, with symptoms including decreased lubrication, pain during intercourse, altered orgasmic sensation, and a feeling of reduced sexual satisfaction.
Pharmacist Anna, 30, had LLETZ procedures in 2014 and a decade later, in 2024.
‘After both, I didn’t have any libido, struggled with lubrication, and while I can get aroused and orgasm, it feels so different – like it’s not happening to me,’ she tells Metro from her home in Cardiff. ‘I’ve also had pain and some bleeding after sex. I didn’t realise this would be an issue because no one mentioned it. I felt quite prepared to look out for signs of infection, but not this.
‘Now, I’m often self-conscious of bleeding, and I worry that it’s going to hurt me when I have sex or that my partner is going to feel the difference. I don’t feel comfortable or as sexy.’
As someone who works in healthcare, Anna was surprised by the lack of opportunity to ask questions before and after the procedure. ‘I’m reluctant to criticise the people involved because I know what the pressure is like, but It felt like a conveyor belt and kind of a tick box procedure,’ she admits.
One of the issues is that the process is streamlined mainly due to time and monetary constraints. Cervical screenings are conducted on 3.5 million women a year, and following any abnormal results, the NHS is under intense pressure to process these swiftly, meaning patients may not get to discuss the procedure with their GP before or afterwards.
Patients will have a short consultation immediately before the LLETZ procedure, but there is no follow up appointment for patients to discuss concerns. All results are communicated by letter or text, and a follow-up cervical screening is conducted six months later.
‘In an ideal world, most healthcare professionals would want that pre-counselling and after-counselling. You would want the patient to feel they have more autonomy and choice,’ says Dr Adesanya.
Without any check-in from their GPs, Rosie, Maddie, and Anna figured out the root of their newfound sexual dysfunction alone by finding a Facebook group with nearly 9,000 members supporting people healing from LLETZ procedures. There, they encountered many other women with similar side effects.
Lots of the posts share struggles to reclaim pleasure after this life-saving procedure, often without the support of doctors. Even after confirming the authenticity of their symptoms, the women still didn’t feel comfortable reporting them, citing fear of dismissal, disbelief, and enduring stigma around women’s sexuality.
Dr Olivia Giovannetti, assistant professor at Queen’s University in Canada, who has conducted several studies into the long-term effects of LLETZ and the information available on it, believes that medical misogyny may play a part in the problem.
‘Women in the eyes of the healthcare system are still very much viewed as the vessel to birth children, and there’s a lack of consideration for sexual pleasure,’ she tells Metro.
‘I get responses, particularly from older men, like ‘well, my patients never complain,’ or they get defensive, saying treating the cancer is more important [than sexuality]. While the greater good is always removing the cancer cells, that doesn’t change the fact that some people are going home unable to connect with their partner or feel like they’ve lost a part of themselves.’
Dr Adesanya adds that more counselling should be offered to women.
‘It’s been trained in our minds that when you request a prostate-related blood test for men, you counsel them to let them know what doing this may mean regarding hospital appointments, biopsies, and procedures,’ she explains. ‘Do we routinely say this to women when inviting them for cervical screening? No. More definitely needs to be done in terms of educational awareness.’
While Rosie acknowledges that the LLETZ is potentially life-saving, sheadmits she would decline the procedure if she could do it all over again.
‘If there’s a 1 in a 100 chance of getting cancer, what would you prefer, that, or 1 in 10 that you will be emotionally scarred, physically scarred?,’ she asks. ‘I would go with the odds of chancing it because, to me, quality of life is more important than its length.’
Meanwhile, although Anna is angry about her treatment, she would still do it again if adequately informed, she admits. ‘The cervical screening test and the HPV vaccine are amazing services that help identify and reduce the risk of cancer, ‘ she says. ‘I just would have felt more prepared with how to deal with the side effects if I’d been told. I would have felt less alone.’
An NHS spokesperson told Metro: ‘This treatment is offered to remove abnormal cells with the aim of preventing cervical cancer, and as with all treatments this has to be balanced against any potential risks associated with the procedure itself, including pain, bleeding or discharge.
‘We’d encourage all patients to discuss any concerns about this procedure with their clinician so that they can make an informed decision about whether to proceed.’
