Vulvectomy is surgery to remove some or all of your outer genitals. The surgery is done to remove diseased areas such as cancer, precancer, or skin disorders such as lichen sclerosus.
The vulva area has many parts. These include the inner and outer labia and the clitoris. The vulva also includes the perineum, the opening of the vagina, and the opening of the urinary tract (urethra).
Vulvectomy can be done in many ways. It depends in part on how big the cancer is and how much tissue is affected. The surgeon may remove only part of the vulva, such as an area of skin from the outer part or the inner part of the labia. Or the surgeon may remove some or all of the outer and inner labia (called a partial or modified vulvectomy). In many cases, the clitoris is left in place. In some cases, all of the vulva is removed along with some of the tissue just under the skin. This is a simple vulvectomy. In very rare cases, the surgeon may do a complete radical vulvectomy. This surgery removes all of the vulva and a larger area of tissue under the skin. It may include parts of the inside of the upper thighs, lower belly, and the area between the vagina and anus (perineum). Lymph nodes in the groin are often removed, too.
Talk with your doctor about the type of surgery you will have. Be sure you understand exactly what will be done and what you can expect afterwards. Know how your body will look, feel, and work after vulvectomy. Don't be afraid to ask questions.
The surgery may be done to treat conditions such as:
Cancer of the vulva
Precancer of the vulva (vulvar intraepithelial neoplasia)
Skin cancer (melanoma) on the vulva
Severe skin disease, such as lichen sclerosus
Severe disease of sweat glands in the groin or vulva (hidradenitis suppurativa)
If you have gone through menopause, your healthcare provider may have you use estrogen cream for a few weeks before surgery. This is to help make the skin in the area healthier before surgery.
This is a general outline of what happens during the surgery:
You lie on an operating table. You're given medicine to relax you or make you sleep through the surgery. You may be given a shot into your lower back to make you numb from the waist down.
A thin, flexible tube (called a Foley catheter) will be put in your urethra. This is to drain urine from your bladder during surgery.
The surgeon cleans the vulva and cuts away the area of diseased tissue. A small amount of healthy tissue around the area is also removed. This is to help make sure all the diseased tissue is gone.
The surgeon will bring together edges of the skin and close them with stitches (sutures) or glue. Many times, small patches of healthy vulva skin are left and can create new tissue. In some cases, a skin graft is needed. This means a piece of healthy skin is taken from another part of your body. The skin graft is then stitched in place over the parts of the vulva that need to be covered.
The surgeon covers the area with a dressing to protect it and help it heal. If a skin graft was done, the spot the skin was taken from (the donor site) will also be covered.
The Foley catheter will likely stay in for up to a week. It drains urine from your bladder while you heal.
While you heal from the surgery, you may need to not do certain activities. You may need bed rest for a period of time. Your doctor will tell you when it's okay to sit up. You may be told to not climb stairs and to limit your walking. You may also need to keep your legs close together. This is to help the incisions heal. You will likely be told to not have sex for several weeks after surgery.
You'll be given pain medicine and medicine to help make it easy for you to have a bowel movement (stool softeners). You will also get instructions on how to keep your vulvar area clean as it heals. You may need to wear loose fitting clothes and not wear underwear for a few weeks.
Urinary tract infection
Changes in sexual function and body image
Need for more surgery to remove more tissue
Blood clots from bed rest
Incontinence or loss of control of the bladder or rectum
Blood blister under the skin (called a hematoma)
Incisions that don't heal
Swelling in your groin or legs (called lymphedema)
Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:
New symptoms or symptoms that get worse
Signs of an infection such as a fever, odor, redness, or drainage
Side effects that affect your daily function or don’t get better with treatment, such as pain or constipation
Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.
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