What is a vulvectomy and how is it performed?

A vulvectomy is removal of part or all of the vulva. The vulva is the outer portion of a woman’s genitals and includes:
• The labia minora and majora (small and large lips). 
• Clitoris. 
• Vestibule. 
• Introitus.
• Urethral meatus.
• Certain glands/ducts. 
It can be used in the treatment of some cases of vulvar cancer. 
The types of vulvectomy include:
• Skinning Vulvectomy: Removal of the top layer of the vulvar skin. 
• Simple Vulvectomy: Removal of the entire vulva. In some cases, the clitoris will be removed.
• Modified Radical Vulvectomy: Removal of the vulva and some of the surrounding lymph nodes and tissue.
• Radical Vulvectomy: Removal of the entire vulva, as well as the surrounding lymph nodes and tissue.
Drains may be placed to remove fluid build-up from the surgical area. These are temporary and will be removed in your doctor’s office. You will be taught how to care for the drains and, if needed, a home care nurse will be able to assist you. Some procedures will require a skin graft, which can be done by a gynaecologic oncologist or plastic surgeon. A skin graft is the removal of skin from one part of the body to close a wound. For women who have had an extensive vulvectomy, reconstructive surgery is an option.

What are the risks and side effects of having a vulvectomy?

There are risks and side effects related to having a vulvectomy. Risks and side effects may be:
• Bleeding, infection and/or blood clots.
• Wound issues such as delayed healing, infections and/or graft site failure, fluid-filled cyst formation.
• Urinary tract infections.
• Lymphedema (swelling) of the legs.
• Change in the appearance of the vulva, decreased libido, genital numbness, which may be temporary.
• Narrowed vaginal opening, decrease in sexual pleasure and/or painful intercourse.
• Discomfort and fatigue.
• Change in urine stream.

What is recovery like?

You may need to stay in the hospital for a few days following your procedure. Often, a bladder catheter will be placed to drain your bladder of urine. 

You will be taught how to clean your genitals and may be instructed to use Sitz baths. You will need to be careful drying your genitals. Your provider will give you specific instructions. If dressings are present, they will be looked at daily and removed when appropriate. 

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

What will I need at home?

• Soft, clean towels for cleaning and drying yourself.

• Sitz bath and a squirt bottle for vulvar hygiene, which is often given to you before leaving the hospital. 

• Hair dryer with a cool setting or a circulating fan to dry the surgical area.

• Thermometer to check for fever, which can be a sign of infection.

• Loose clothing, cotton underwear.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anaesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.