When cancer is found in the vulva, the external area of the vagina (labia and so on), a common treatment is a vulvectomy.
Vulvectomy comes from the root word ‘vulva’ and the suffix ‘-ectomy’ (meaning ‘removal’). In essence it means surgical removal of the vulva, which can be complete or partial, and yes, it’s terrifying. Modern surgery, however, is starting to do a pretty good job of cleaning up the messes left by cancers.
Types of vulvectomy
Partial vulvectomy is removal of only the affected part, plus a margin of tissue surrounding the cancer area.
Modified radical vulvectomy is the removal of the affected part, margin of tissue surrounding the cancer area plus groin lymph nodes.
Radical vulvectomy is the removal of the whole vulva. This includes the inner and outer lips and the clitoris. This type of operation is rarely done.
How does it feel after the procedure? There may be some numbness in the groin area but usually the sense of feeling returns after a few weeks or months. You may feel pain or discomfort when wearing tight pants and your genital area might look quite different than you are used to. You should be able to get pregnant normally, but discuss this with your doctor, since other cancer treatments will need to be taken into consideration.
You have the option to have reconstructive surgery especially if you had undergone radical vulvectomy.
Those whose groin lymph nodes had been removed might experience what is called lymphoedema, a swelling of the groin area or the legs.
It’s possible in some cases that chronic pain and discomfort results from genital surgery – this is a risk. Chronic nerve pain is a terrible suffering, and so it’s important that you have only the best surgeon. Make sure they have done the operation many times previously with excellent outcomes. If you have any doubts at all, find another surgeon.
What you will look like after surgery
Initially, very swollen and bruised, but this heals up, and what your vaginal area will look like will depend on how comprehensive the surgery was. It may be shocking to look at your vaginal area without your labia, so getting used to this and learning to accept your new body is important, but takes time.
Vulvectomy and sex
You might have a problem reaching orgasm after having vulvectomy, depending on how much of the vulva has been removed. The clitoris and outer lips of a woman’s genitalia are important components in sexual pleasure and arousal, so if these are removed, the sensation is lessened, or the ability to feel pleasure is removed.
One of the major hurdles for pleasurable sex is self-esteem and your feelings about the way your vagina looks to your partner. This is inevitable, and you will need to figure this out as you go. Acceptance is the only way to deal with it, so focus on first grieving, and then when you’re ready, with your partner, talk about how you can move forward with your sex life and see what’s possible. Get professional help where possible, as you find your own way. Every couple will approach this differently, but a successful, happy, orgasmic sex life is possible after many vulvectomia.
Your emotional response to a vulvectomy
This can be really devastating for many women, and it’s not something to be taken lightly. Seek emotional support from friends and family, and counselling from a professional, because you are going to need it! Some of us are going to respond more severely than others. You will need some time to grieve for your old body, and accept the new one, and grief counselling may be appropriate. No matter what, the feelings you are likely to experience will be grief, shock, anger, and fear, along with a loss of confidence. It can feel like you have been utterly violated.
These may all be mixed in with relief at having beaten cancer, at least for now.
Remember that other women have gone through this and come out the other side. There is life after a vulvectomy.