A vulvectomy is a procedure that removes all or part of the vulva. Occasionally the surgeon will also remove the clitoris. The aim of the procedure is to remove cancerous, precancerous, or other unhealthy tissue. A vulvectomy is the principal treatment for vulvar cancer. In some circumstances it is also used to treat certain skin diseases.
The amount of vulva your surgeon removes will depend on the severity your cancer or other health condition you may have.
What is The Vulva?
The vulva is the outer part of a woman’s genitals and includes the:
- Labia majora (large lips)
- Labia minora (inner small lips)
- Clitoris (the sexual organ that helps women reach sexual climax)
- Urethral meatus (the point where urine exits the urethra)
- Gland and ducts (including Bartholin's glands which are 2 small glands each side of the vagina)
- Vestibule (part of the vulva between the labia minora)
- Introitus (the opening to the vagina)
What Conditions Does A Vulvectomy Treat?
A vulvectomy is performed to remove diseased areas such as cancer, precancer, or skin disorders such as lichen sclerosus. It is also performed to treat severe sweat gland diseases.
Vulvar cancer is a rare type of cancer that occurs on the outer surface area of the female genitalia. It mostly occurs in women over the age of 65. Vulval cancer commonly forms as a lump or sore on the vulva that causes soreness, itching and painful urination. Vulvar cancer includes skin cancers such as squamous cell carcinoma and vulvar melanoma.
The main treatment for vulvar cancer is surgery to remove the cancerous tissue from the vulva and any nearby lymph nodes that may contain cancerous cells. The size and depth of the tissue removed depends on the severity and extent of the cancerous cells. Some women may also have radiotherapy or chemotherapy in conjunction with a vulvectomy.
Lichen sclerosus is a chronic condition that causes thin, white patches of skin, usually in the genital area. It can cause discomfort, itching and easy bruising or tearing of the skin. This condition occurs mostly in girls who have not started menstruating and in postmenopausal women.
Although the exact cause of lichen sclerosus is unknown, it is thought to be related to genetics, autoimmune disorders, hormonal imbalances, and infection. Although the condition is not cancerous, constant inflammation may cause precancerous cells to develop. Treatment options include topical steroids and laser ablation. A vulvectomy is only performed as a last resort after more conservative treatments have failed.
Vulvar Sweat Gland Diseases
Fox-Fordyce disease is a rare, chronic skin disorder that occurs when the apocrine sweat duct becomes blocked. It is usually treated conservatively with treatments such as topical steroids but in severe cases it may be necessary to remove diseased tissues.
Types Of Vulvectomy Procedures
These are the various types of vulvectomy procedures your doctor could recommend depending on your health and the severity of your condition. Surgical options include:
This procedure involves removing the top skin layer of the vulva.
Depending on the location of the diseased area, this surgery may involve removing some of the outer and inner labia, the clitoris, urethral meatus and possibly the lymph nodes in the affected area.
The surgery requires removing the entire vulva. This is normally necessary if there is extensive diseased tissue. Surgery entails removing the outer and inner labia, subcutaneous tissue and possibly the clitoris.
Modified Radical Vulvectomy
The procedure entails removing vulvar tissue and some of the nearby lymph nodes and tissue.
This procedure requires the removal of the entire vulva in addition to deep surrounding tissue, the clitoris and lymph nodes.
Recovering From A Vulvectomy
Familiarising oneself with the recovery stages of a vulvectomy can enhance a womens experience, as we detail typical pre and post-surgery protocols, encompassing rest duration, medications, and other relevant aspects.
Before surgery, a catheter is inserted into the bladder and remain in place until you can urinate on your own. After the operation your surgeon is likely to insert one or more drains into the operation site to encourage fluid drainage. This is later removed in an out-patient setting after the wound has healed sufficiently.
Patients usually remain in the hospital for up to 3 days following surgery. You may receive oxygen via a nasal cannula. You will usually also be given compression stockings or boots to wear to encourage ongoing blood circulation.
Patients should not sit upright until advised to by their doctors. Once sitting is allowed, you will be given an inflated doughnut-like device or a soft pillow to sit on to protect the site. While still in hospital, women receive instructions on how to care for their wound. Proper perineal care is important to prevent infection.
Your doctor will prescribe medications for pain relief, blood clot prevention and antibiotics to prevent infection. Women may need stool softeners or laxatives to make their bowel movements easier.
Leaving the Hospital
Once discharged from hospital, women must continue to care for their wound as directed by their doctor. Handwashing before and after wound care is vital to avoid infection. Wearing clean clothes and using clean towels should be done to prevent infection. Wearing loose clothing and underwear helps to minimise discomfort.
Risks And Side Effects
As with any surgical procedure, vulvectomies carry possible postoperative risk factors or side effects. These include:
- Following surgery, the operation site may be swollen, bruised and painful.
- Depending on the extent of tissue removal, the vulva may be noticeably different in appearance.
- Symptoms of an infection such as fever or an unusual discharge. You should advise your doctor if you develop these symptoms.
- A blood clot may form internally, break loose and lodge elsewhere in the body. You should seek immediate medical attention if you start to have trouble breathing, chest pain or an unusual headache.
- Some women develop urinary tract infections. This needs to be reported to your doctor.
- You may have a received a reconstructive skin graft to aid in the healing process. In rare instances, the graft may fail.
- Narrowing of the vaginal opening may lead to painful sex.