Vulvectomy

What is the term Vulvectomy?

Vulvectomy is a surgical procedure to remove all or part of the outer female genital organs (vulva). The vulva includes the outer and inner lips of the vagina and the clitoris. You may need this surgery if you have a cancerous growth in your vulva.

There are two types of vulvectomy:

• A simple vulvectomy. This is the removal of the entire vulva.
• A radical vulvectomy. A radical vulvectomy can be partial or complete.
  • A partial radical vulvectomy is when part of the vulva and surrounding deep tissue is removed.
  • A complete radical vulvectomy is when the vulva, clitoris, and surrounding deep tissue is removed.

During a radical vulvectomy, some lymph nodes near the vulva may also be removed.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks of Vulvectomy?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Urinary tract infections.
• Lymphedema. This is when your legs swell after the removal of lymph nodes from your groin area.
• Pain or decreased sexual pleasure when having sex.
• Long-term vaginal swelling, tightness, numbness, or pain.
• A blood clot that may travel to the lung (pulmonary embolism).

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
• A tube (catheter) may be inserted through the outer opening of your bladder (urethra) to drain urine during and after surgery.
• Depending on the type of vulvectomy you are having, your surgeon will make an incision and remove the affected area. This may include:
  • Removing the entire vulva.
  • Removing part of the vulva, surrounding deep tissue, and lymph nodes.
  • Removing the vulva, clitoris, surrounding deep tissue, and lymph nodes.
• If your lymph nodes are removed, a drain may be placed in the area to help avoid fluid buildup.
• Your incisions will be closed and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will get medicine for pain as needed.
• You may get medicine to prevent constipation.
• You may be on a liquid diet at first, and then switch to a regular diet.
• When you are taking fluids well, your IV will be removed.
• If your catheter was left in place after surgery, it will be removed when your health care provider approves.
• You will be asked to breathe deeply and to get out of bed and walk as soon as you can.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• Do not drive for 24 hours if you received a sedative.

Care After the Surgery

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Vaginal pain.
• Vaginal numbness.
• Vaginal swelling.
• Bloody vaginal discharge.

Follow these instructions at home:

Activity

• Rest as told by your health care provider.
• Do not lift, push, or pull more than 5 lb (2.3 kg).
• Avoid activities that require a lot of energy for as long as told by your health care provider. This includes any exercise.
• Raise (elevate) your legs while sitting or lying down.
• Avoid standing or sitting in one place for long periods of time.
• Do not cross your legs, especially when sitting.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• After passing urine or a bowel movement, wipe yourself from front to back and clean your vaginal area using a spray bottle.
• If told by your health care provider, take a sitz bath to help with discomfort. This is a warm water bath you take while sitting down.
  • Do this 3–4 times per day, or as often as told by your health care provider.
  • The water should only come up to your hips and cover your buttocks.
  • You may pat the area dry with a soft, clean towel. If needed, you may then gently dry the area with a hair dryer on a cool setting for 5–10 minutes. An enclosed box fan may also be used to gently dry the area.

Incision Care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, adhesive strips, or surgical clips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Lifestyle

• Do not douche or use tampons until your health care provider approves.
• Do not have sex until your health care provider approves. Tell your health care provider if you have pain or numbness when you return to sexual activity.
• Wear comfortable, loose-fitting clothing.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative).

General Instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Take a stool softener to help prevent constipation as told by your health care provider. You may need to do this if you are taking prescription pain medicine.
• Drink enough fluid to keep your urine clear or pale yellow.
• If you were sent home with a drain, take care of it as told by your health care provider.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.
• You have painful or bloody urination.
• You feel nauseous or you vomit.
• You develop diarrhea.
• You develop constipation.
• You develop a rash.
• You feel dizzy or light-headed.
• You have pain that does not get better with medicine.
• Your incision breaks open.

Get help right away if:

• You faint.
• You develop leg or chest pain.
• You develop abdominal pain.
• You develop shortness of breath.