A Guide to a Vulvectomy Procedure

Everything you need to know about this preventative procedure for women

A vulvectomy involves the removal of precancerous or cancerous tissue located on the external genitalia of women. Different classifications of the vulvectomy refer to the size and depth of the tissue removed depending on the severity and extent of the diseased cells.

Vulvectomy procedures require removing part or all of the vulva, which includes the following anatomical sites:

Labia majora (large lips)

Labia minora (inner small lips)

Clitoris

Urethral meatus

Lymph nodes

Types of vulvectomy procedures

These are the various types of vulvectomy procedures your doctor could recommend depending on your health and condition.

Skinning vulvectomy. This procedure involves removing the uppermost skin layer of the vulva.

Partial vulvectomy. Depending on the location of the diseased area, tissue removal may be necessary on one side, both sides, the top or bottom of the genital area. The surgery requires removing some of the outer and inner labia, possibly the clitoris, urethral meatus and possibly the lymph nodes in the affected area.

Simple vulvectomy. The surgery requires removing the entire vulva. The extent of the diseased tissue involves removing outer and inner labia, subcutaneous tissue and possibly the clitoris.

Modified radical vulvectomy. The procedure entails removing vulvar tissue in addition to some deep surrounding tissue and local lymph glands.

Radical vulvectomy. The extent of the diseased tissue requires the removal of the entire vulva in addition to deep surrounding tissue, the clitoris and lymph nodes.

Following the removal of the tissue containing abnormal cells, and before closing the surgical site, surgeons commonly insert one or more drains into the site in order to encourage fluid drainage. Once a predetermined level of healing occurs, a physician removes the drain(s) in an out-patient setting.

Vulvectomy post-op care and recovery

Patients typically remain in the hospital for up to 3 days following a vulvectomy. Prior to surgery, a catheter is commonly inserted into the bladder to ensure unobstructed urine flow. The catheter remains in place as needed.

Upon completion of the surgery, patients are taken to the recovery room for monitoring and observation. Vital signs are routinely checked. Women may receive oxygen via a nasal cannula. The bladder catheter remains in place. The lower legs commonly have compression boots to encourage ongoing blood circulation.

Once awake, the patient moves to a room on the surgical floor. Patients should not sit upright until instructed to do so in order to prevent the surgical site from being compromised. Once sitting is allowed, women often receive an inflated donut-like device or a soft pillow to sit upon to protect the site.

Any dressings are checked daily and changed as needed. While hospitalized, women receive instructions as to how to care for the surgical site. Perineal care performed properly is important to prevent infection.

Physicians may prescribe medications for pain relief, blood clot prevention and antibiotics to deter infection. A diet rich in fruits, vegetables and whole grains along with plenty of fluids helps prevent constipation. Women may need stool softeners or laxatives to aid in resuming normal bowel movements.

Once home, rest and proper nutrition are necessary for healing to occur. Women must continue caring for the surgical site as directed. Handwashing before and after wound care is important. A simple squirt bottle filled with clean water is often recommended for cleanliness. Clean clothes and towels must be used to prevent infection.

Women may be instructed to take a sitz bath to deal with any discomfort. A small fan or a hairdryer on the cool setting may also provide relief. Wearing loose clothing and underwear minimizes surgical site discomfort.

Risks and side effects of vulvectomies

As with any surgical procedure, vulvectomies carry possible postoperative risk factors or side effects. Following surgery, the site may be swollen, bruised and painful. Depending on the extent of tissue removal, the vulva may be noticeably different in appearance. However, women are advised to consult with a physician should the surgical site become more swollen, warm and red. You may develop a fever or notice an unusual discharge. These are all symptoms of a possible infection.

A blood clot may form internally, break loose and travel anywhere in the body. Abnormal swelling may occur in one or both legs secondary to lymphedema or a blood clot. Any difficulty breathing, chest pain or an unusual headache may be symptoms of a thrombosis, which requires immediate medical attention.

Some women develop urinary tract infections. Painful urination, frequent urination or difficulty while urinating must be reported to your physician. The surgery and subsequent tissue trauma may cause the alteration of the urine stream.

If the procedure required excessive tissue removal, you may have also received a reconstructive graft to aid in the healing process. In rare instances, the graft may fail.

The genital area may temporarily feel numb. Narrowing of the vaginal opening may lead to painful intercourse. You may also experience a loss of libido.

Importance of routine gynecological exams

Women of all ages are advised to have an annual gynecological exam. Routine examinations and pap smears increase the likelihood of early diagnosis and treatment. Consult with a gynecologist at All About Women MD for routine care or concerns. If genitourinary precancerous or cancerous symptoms are a current concern, we are happy to explain your options and procedures.