• Vulvectomy

    (Skinning Vulvectomy; Partial Vulvectomy; Radical Vulvectomy; Simple Vulvectomy; Vulvectomy—Skinning; Vulvectomy—Partial; Vulvectomy—Radical; Vulvectomy—Simple)

    Definition

    A vulvectomy is done to remove the vulva or parts of it. The vulva is made up of the genitals located on the outside of a female’s body. These genitals are the clitoris, labia majora, and labia minora.
    Female Genitalia
    si55550966 96472 1 vulva.jpeg
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    This is done to remove cancerous cells from the vulva. It may be able to cure vulvar cancer. It can also be done to remove abnormal skin, like warts.

    Possible Complications

    If you are planning to have a vulvectomy, your doctor will review a list of possible complications, like:
    • Bleeding
    • Pain, numbness, or tenderness of the vulva
    • Wound not closing properly
    • Infection
    • Blood clots in the legs
    • Tightness or dryness of the vagina
    • Reaction to anesthesia
    Smoking may increase the risk of complications.
    Discuss these risks with your doctor.

    What to Expect

    Prior to Procedure

    Before the surgery, your doctor may:
    • Do a physical exam and review your medical history
    • Perform blood and imaging tests
    • Talk to you about any medicines, herbs, and dietary supplements you may be taking—You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners (eg, warfarin , clopidogrel )
    Before the surgery:
    • Arrange for a ride to and from the hospital.
    • The night before surgery, do not eat or drink after midnight.

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

    Description of the Procedure

    A nurse will insert an IV into your arm. This will deliver antibiotics. Your pubic hair will be removed. The nurse will also insert a catheter to drain urine from your bladder.
    There are several types of vulvectomy surgery. The type you will have depends on what parts of the vulva and nearby tissue have been affected by cancer or abnormal skin. Examples include:
    • Skinning vulvectomy—removes the top layer of skin
    • Simple vulvectomy—removes multiple layers of skin and tissue
    • Partial vulvectomy—removes a part of the vulva, as well as some nearby tissue and lymph nodes
    • Radical vulvectomy—removes the entire vulva, including nearby tissue and lymph nodes
    Once all affected areas have been removed, the doctor may need to reconstruct the vulva. If only a small amount of skin was removed, she may be able to stitch the remaining skin together. Sometimes, a skin graft is needed. Temporary drains may be inserted to remove extra fluids from the incision area.

    How Long Will It Take?

    About 1-2 hours

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. Your doctor will give you pain medicine after surgery.

    Average Hospital Stay

    The hospital stay depends on the type of surgery. You may go home the same day or up to a few days after. If you had any problems, you will need to stay longer.

    Post-procedure Care

    At the Hospital
    While in the hospital, you may be asked to:
    • Begin drinking clear fluids. You will slowly progress to solid food.
    • Do breathing exercises to help prevent chest infections.
    • Get up and walk to relieve gas and prevent blood clots.
    The catheter and drains may be removed within a week.
    At Home
    When you return home, you may be asked to do the following:
    • If you have a dressing, follow instructions for changing and removing it.
    • Keep your legs apart.
    • After a bowel movement, wipe yourself from front to back.
    • Take a sitz bath three times a day and after a bowel movement—A sitz bath is soaking the hip and buttocks area in warm water. You can buy a plastic sitz bath at most drugstores. Or you can use your bathtub.
    • Clean the area with natural soap (eg, glycerin) or plain warm water.
    • Keep the vulvar area dry. Dry yourself with a clean towel or use a hair dryer at a low setting.
    • Wear loose clothing and cotton underwear.
    • Avoid wearing pantyhose or girdles.
    • Move your legs while you are in bed to prevent blood clots.
    • Your doctor will let you know when you can have sex again.
    • Follow your doctor’s instructions.
    Ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, tenderness, a lot of bleeding, or discharge from the surgery site
    • Pain, redness, hot skin, or swelling in your legs
    • Burning or pain when urinating
    • Pain not controlled by the medicine given
    • Nausea or vomiting
    • Abdominal pain, chest pain, or trouble breathing
    • Wound opens
    In case of an emergency, call for medical help right away.

    RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org/

    Women's Health.gov http://www.womenshealth.gov/

    CANADIAN RESOURCES

    The Society of Gynecologic Oncology of Canada http://www.g-o-c.org/

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    After surgery for vulval cancer. Macmillan Cancer Support website. Available at: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Livingwithvulvalcancer/Aftersurgery.aspx . Updated June 1, 2009. Accessed November 26, 2010.

    Dictionary of cancer terms. National Cancer Institute website. Available at: http://www.cancer.gov/dictionary/?CdrID=443588 . Accessed November 26, 2010.

    Dictionary of cancer terms. National Cancer Institute website. Available at: http://www.cancer.gov/dictionary/?CdrID=443589 . Accessed November 26, 2010.

    Gynecology surgery. Wellscape website. Available at: http://www.medical-travel-medical-tourism.com/gynecology/ . Accessed November 26, 2010.

    Having your operation for vulval cancer. Cancer Research UK website. Available at: http://www.cancerhelp.org.uk/type/vulval-cancer/treatment/surgery/having-your-operation-for-vulval-cancer . Accessed November 26, 2010.

    Jolicoeur L. Vulvectomy—a patient's guide. The Society of Gynecologic Oncology of Canada website. Available at: http://www.g-o-c.org/en/patientadvocacy/cancers/vulvptguide.aspx . Accessed November 26, 2010.

    Surgery for vulval cancer. Macmillan Cancer Support website. Available at: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Vulva/Treatingvulvalcancer/Surgery.aspx . Updated September 1, 2009. Accessed November 26, 2010.

    Vulvar cancer treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/vulvar/Patient/page4 . Accessed November 26, 2010.

    Which surgery for vulval cancer? Cancer Research UK website. Available at: http://www.cancerhelp.org.uk/type/vulval-cancer/treatment/surgery/which-surgery-for-vulval-cancer . Accessed November 26, 2010.

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