What Is the Vulvectomy Procedure?
Vulvectomy is a surgical procedure that involves the vulva (a part of the female sexual organ on the external body surface). The surgery is mainly done in case of cancer of the vulva. The vulva includes:
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Vaginal opening.
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Clitoris.
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Inner and outer folds of labia.
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Vaginal glands (present between vulva and anus).
There are different types of vulvectomy surgeries. The type of surgery one needs depends on the part of the vulva that is affected by some abnormal condition and needs to be removed.
The different vulvectomy procedures include:
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Skinning Vulvectomy - the procedure involves the removal of the top skin layer.
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Radical Vulvectomy - the procedure involves the removal of the entire vulva, nearby tissues, and occasionally lymph nodes.
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Partial Vulvectomy - the procedure involves the removal of a part of the vulva, nearby tissues, and occasionally lymph nodes.
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Simple Vulvectomy - the procedure involves the removal of multiple skin and tissue layers.
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Wide Local Excision - the procedure involves the removal of abnormal skin and some normal skin.
After the removal of the abnormal areas, reconstruction of the vulva may be necessary. A skin graft or flap may be needed in some cases. A skin graft is a thin layer removed from another site such as the groin or thigh.
What Are the Issues One Faces After the Vulvectomy Procedure?
The potential risks that may develop during the procedure are:
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Severe bleeding, in which case blood transfusion is needed.
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Anesthetic complications.
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Blood clot formation in the lungs or legs may result in signs like pain, swelling, and shortness of breath.
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A less than one in a thousand chance for death.
One may face some psychological and physical side effects following the vulvectomy procedure. Most of these complications are milder, but they can sometimes be severe. The side effects one may experience mostly depend on the type of surgery one has undergone.
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Psychological Impact:
It takes time for one to come to terms with the surgery and the potential side effects. The emotions one experiences differ from the other. Some may be concerned about the appearance of their vulva immediately following the surgery, but that may not be the case with some others. One should feel free to talk with one’s physician or specialist nurse if one cannot cope well after the surgery. One may also get help from social and community support groups.
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Impact on Sexual Life:
Most women can return to their sexual life after the wound has been healed. The healing time varies from about 6 to 8 weeks. Following the vulvectomy procedure, some may find a decline in sexual pleasure, especially in cases where the clitoris was removed. Some may experience numbness in the genital region following the procedure, mostly due to nerve damage. Healing can occur, but it may take time.
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Numbness:
Depending on the type of surgery one has undergone, nerve damage may occur, resulting in the following side effects:
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Complete numbness in certain regions.
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Tingling sensation.
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Pins and needles.
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Unexplained cold or hot areas.
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Mild electric shock-like feeling.
The region in which one experiences these feelings depends on the damaged nerve. One may experience it in the groin, between the legs, or down the legs. The damage gets healed over time, but in some cases, the damage may be permanent.
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Scarring:
Scar tissue may be formed around the vulvar region following the surgery. The scar tissue is less stretchy and is stiffer. If scar tissue develops around the vagina, then vaginal opening becomes narrower and penetrative sex can be painful. Scar tissue can change the shape and size of the remaining vulvar region. Pain may be present in scar tissue regions.
In case of narrowed vaginal opening, vaginal dilators can be used. Dilators are cone-shaped smooth objects that are inserted into the vagina and are used for stretching it. They are available in different sizes and are used with a lubricating gel.
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Swelling of the Leg and Groin:
Swelling in and around the genital region following a few weeks after surgery is a common finding. But if swelling persists or swelling of the legs is seen, the condition is mostly lymphedema. Swelling that occurs due to the buildup of lymph fluid is called lymphedema. The chances of developing lymphedema are higher in cases where lymph nodes of the groin were removed during the surgery. The treatment options include:
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Manual lymphatic drainage.
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Compression bandaging.
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Specially fitted stockings.
In the case of lymphedema, one should take care of the following:
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Protect one’s leg from sharp objects (avoid walking barefoot).
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Take extra care while trimming toenails.
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Avoid sunburn.
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Use insect repellant to protect from insect bites.
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If shaving the legs, use an electric razor.
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Bowel and Bladder Issues:
Most women who have undergone surgery do not have bladder or bowel issues. However, taking plenty of fluids to prevent constipation is recommended, which may delay wound healing. Adequate intake of fluids also reduces the risk of developing urinary infections. If bladder infection occurs, it can result in frequent urge to urinate and burning pain during urination.
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Pelvic Exenteration:
Pelvic exenteration involves the resection of the rectum, anus, ureter, bladder, and pelvic reproductive structures. It is done in cases where vulvar cancer spreads from the vulva to other regions such as the bowel, bladder, or womb. It is an uncommon occurrence.
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Recurrence:
In some cases, the return of the disease can occur.
When to Seek Medical Care?
Immediate medical attention should be sought if one develops the following symptoms after the vulvectomy procedure:
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Excessive bleeding.
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Offensive-smelling discharge.
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Persistent vomiting, cases where one cannot take fluids and food.
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Problems while passing urine.
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Chills, shaking, and fever.
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Severe pain which cannot be controlled with pain relief medication.
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Wound infection signs like tenderness, redness, swelling, drainage, etc.
Conclusion
Certain mild side effects are common with vulvectomy procedures. The development of side effects mainly depends on the type of surgical procedure and the extent of the surgery. In case of severe or persistent side effects or signs of fever or infection, immediate medical care is needed. One should follow all the postoperative instructions per the physician’s guidance to reduce the risk of developing side effects.
