Vulvectomy

The vulva, the outer portion of the genitalia, is made up of the labia minora, labia majora, clitoris and perineum area. Non-cancerous, pre-cancerous and cancerous lesions may develop on the vulva. Some may require surgical treatment. One such treatment, called a vulvectomy, removes part or all of the vulva. There are different types of vulvectomy procedures, ranging from partial to full, simple or radical, depending on the location and severity, stage or type of vulvar disease.

The treatment for vulvar cancer may require radical vulvectomy with or without the removal of the nearby lymph nodes. During this surgery, all or parts of the vulva are removed, sometimes along with surrounding tissues and groin lymph nodes.

Doctors try to leave as much healthy tissue intact as possible, examining tissue beyond the tumor before removing it. More extensive vulvectomies sometimes lead to complications, so the patient’s sex life, as well as her ability to urinate and pass stool, are considered when discussing whether this surgery is appropriate.

Why is a vulvectomy performed?

The reasons a vulvectomy may be performed include:

• Vulvar cancer
• Vulvar intraepithelial neoplasia (VIN)
• Melanoma of the vulva
• Severe skin diseases such as lichen sclerosus 
• Diseases of the sweat glands

Types of vulvectomy

One of several types of vulvectomy procedures may be recommended, including:

Skinning vulvectomy: Although rare, this procedure is performed to remove the uppermost layer of skin, and it can be performed in cases of severe VIN.

Simple partial or total vulvectomy: During this procedure, the skin along with some of the tissue below the skin are removed.

Partial or modified radical vulvectomy: This surgery partially removes the vulva and deep surrounding tissue.

Complete radical vulvectomy: This type of vulvectomy removes the clitoris and entire vulva, as well as deep surrounding tissues, possibly including the inside of your upper thighs, lower belly, and/or the perineum. This procedure is quite rare.

How to prepare for a vulvectomy

The following practices are typical of what you can expect before your vulvectomy:

• You’ll likely be advised not to eat or drink anything after midnight the evening before the surgery.
• Your doctor will discuss your medications with you and let you know whether you need to stop taking any of them.

If you have any questions, be sure to ask them before your procedure.

What to expect after a vulvectomy

After a simple vulvectomy, you’ll probably be discharged from the hospital on the day of your surgery. Soreness around the affected area is normal, but your healing should be complete in about two to four weeks.

You can expect the following after your procedure as you work toward recovery:

• Your care team will instruct you on postoperative care to keep the area clean.
• You may or may not have a Foley catheter in place for up to a week. This will help drain your urine while you heal.
• You’ll probably need to limit certain activities, including closing your legs, sitting up, climbing and/or walking during this period of recovery.
• Your doctor can let you know when it’s safe to resume sexual activity.
• Recovery from a radical vulvectomy due to cancer may also involve a treatment plan created by your care team to help reduce the risk of recurrence. Your doctor may recommend additional chemotherapy or radiation treatment after the vulvectomy. Typically, this means additional follow-up visits at three- to six-month intervals.
• If a large area of tissue is removed, you may be a candidate for vulvar reconstruction, a procedure that uses skin and fat grafts from other areas of your body. The procedure may be performed by a gynecologic oncologist or plastic/reconstructive surgeon.

Vulvectomy benefits

If you have cancer, the goal with any type of vulvectomy is to eradicate as much of it as possible, as well as to prevent it from spreading, while preserving your quality of life.

A vulvectomy has the greatest chance of success when cancer is in earlier stages.

Vulvectomy risks

Ask your care team about the risks and complications after a vulvectomy so that you have the knowledge to help make good treatment decisions. Possible risks after a vulvectomy include:

• Infection at the surgical site, or issues with the wound site
• Urinary tract infection or altered urine stream
• Scarring at the incision site
• Body image challenges
• Sexual function changes
• The need for additional surgery
• Blood clots due to lack of circulation during bed rest
• Excessive bleeding
• Incontinence (bladder or rectum)
• Hematoma (a blood blister that forms under your skin)
• Issues healing
• Lymphedema (swelling in the groin/legs after lymph node removal)
• Pain and fatigue caused by lymphedema
• Narrowing of the vagina
• Painful sex or lack of sexual desire/difficulty reaching orgasm
• Diminished genital sensitivity
• Changes to the appearance of your vagina
• Discomfort when wearing tight clothing

If you experience signs of infection, such as fever, foul odor, redness around the surgical site or wound drainage, or if you have new or worsening symptoms that don’t improve, you should contact your doctor immediately.

Vulvectomy results

The results of your vulvectomy will depend on your specific case, including the extent of your condition. The need for vulvar reconstruction and/or additional cancer treatment will also depend on your unique circumstances. Your care team can help you find resources for coping and support.