Gynaecology

Vulvectomy

at Cadogan Clinic, Leaders in Women’s Health and Wellness.

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What is Vulvectomy?

A vulvectomy is surgery to remove some or part of the vulva, the outer portion of the female genitals. The surgery is commonly carried out to treat vulval cancer and skin cancer and to remove precancerous or unhealthy tissue, for example tissue that has been affected by severe skin disease such as lichen sclerosus. Vulvectomy is also used to treat severe sweat gland diseases. The amount of tissue to be removed during vulvectomy surgery depends on how far the cancer has progressed. If only a small portion of the vulva has been removed then the remaining tissue can be neatly stitched back together. However if a larger area of tissue has been removed then reconstructive surgery may be necessary using skin taken from another part of the body, such as the thigh or abdomen. Depending on the severity of the cancer, the surgeon may also remove some or all of the lymph nodes in the groin during the same procedure.

It can take several weeks for a woman to make a full recovery from vulvectomy surgery.

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Why might a person require a Vulvectomy?

There are several reasons why a woman may require a vulvectomy:

Vulval cancer is a rare type of cancer that affects a woman’s external genitals. This includes the labia minora and labia majora (the lips surrounding the vagina), the clitoris and the Bartholin's glands, which are two small glands located on each side of the vagina.

Vulval cancer is more common in older women aged over 65. It is rare in women aged under 50 who have not yet gone through menopause.

Melanomas can appear on the vulva like any other part of the body. Most are black or dark brown, but they can be white, pink, red, or other colours. Although melanomas can be found anywhere on the vulva, they are more common around the clitoris, labia minora and labia majora. If you have a mole on your vulva, it is important to check for any changes, such as changes in size, shape, symmetry or colour.

Precancerous changes that occur in the surface layer of cells of the vulva are known as vulvar intraepithelial neoplasia (VIN). These abnormal cells develop slowly, usually over the course of several years. Sometimes these cells may turn cancerous, but they don’t in most cases.

Lichen sclerosus is a skin condition which causes white patches to develop on the genitals and other parts of the body. It can affect adults and children but it is much more common in women aged over 50.

The condition is characterised by itchy, white patches, which may be smooth or crinkled. These are easily damaged and often hurt or bleed if scratched, rubbed or irritated. The patches can appear anywhere on the body but in women they are more often found on the vulva or anus. Although the condition can be managed, skin affected by lichen sclerosus may become scarred and tight over a period of time. This may cause the vulva to shrink, affecting the clitoris and labia minora. This can cause discomfort during sex and when going to the toilet. If this is severe, then a vulvectomy may be needed.


What are the different types of Vulvectomy surgery?

There are several different types of vulvectomy surgery. How much of the vulva is removed is dependent on the severity of the cancer or health condition and how far it has spread.

  • Skinning vulvectomy: This is the least invasive vulvectomy surgery. In a skinning vulvectomy, a surgeon only removes the top layer of the skin, leaving most of the structure of the vulva and surrounding tissue intact. This is commonly used to treat vulvar intraepithelial neoplasia (precancerous cells).
  • Simple vulvectomy: In this type of vulvectomy surgery, the entire vulva is removed. This means the inner and outer labia and the tissue just underneath the skin. Sometimes the clitoris is removed too, depending on the patient’s condition.
  • Modified radical vulvectomy: Also known as a partial radical vulvectomy, in this surgery most, but not all, of the vulva is removed, along with some of the lymph nodes and surrounding tissue.
  • Radical vulvectomy: In a radical vulvectomy, the surgeon removes the entire vulva, including the labia majora, labia minora, clitoris, any other surrounding tissue and lymph nodes.

Some of these procedures involve the removal of large amounts of skin from the vulva. If this is the case, then reconstructive surgery may be required. This involves taking a piece of skin and underlying fatty tissue from one part of the body and using it to reconstruct the vulva. Another option is to have a skin flap, where the surgeon turns an area of skin near the vulva into a flap to cover the wound. However sometimes just stitches are enough if only a smaller amount of tissue has been removed.

 


What to expect during Vulvectomy surgery?

Your vulvectomy surgery will take place under a general anaesthetic as a day case at our Chelsea clinic.

Once you have been given the anaesthetic to put you to sleep, a catheter will be inserted into your bladder to drain urine.

The surgeon will then proceed to remove part or all of your labia minora, labia majora, clitoris, tissue or lymph nodes, depending on the extent of the surgery. Vulvectomy surgery takes around two to three hours, once again depending on how much is being removed. This may take longer if reconstructive surgery is taking place at the same time.

After vulvectomy surgery, the surgeon will close the wound with dissolvable stitches.

After the procedure is complete, you will need to rest and wait for the effects of the anaesthetic to wear off. You are likely to need pain relief.

Once you are able to eat and drink, and our specialist nursing team are happy that your initial recovery is complete, you will be allowed to leave the clinic with a friend or family member.


What is the recovery time from Vulvectomy surgery?

The recovery time from vulvectomy surgery depends on the extent of the surgery. It usually takes around six to eight weeks to recover.

Following your vulvectomy surgery, you may feel weak and tired for a few days or weeks and may find you need to rest more than usual. You may also experience a brownish discharge - this is normal. You should avoid tight clothing and avoid doing too much walking until the affected skin has healed.

Penetrative sexual intercourse, tampons and swimming should all be avoided for six to eight weeks. You should not drive for at least six weeks, or until you can comfortably perform an emergency stop.

Although vulvectomy stitches are dissolvable they can become tight. If this is the case, they can be removed earlier, depending on how well the wound is healing.

It is crucially important that you keep the wound area clean and dry to help with healing. This will also help to prevent infections.

You should shower the wound area with lukewarm water and dry with a non-shedding cloth or cool hair dryer at least three times a day or after going to the toilet.

It is important to follow all the aftercare advice issued by your surgeon following your vulvectomy. Failure to do so may delay healing and impact upon the final result.


What are the risks and complications of a Vulvectomy?

The risks and complications of a vulvectomy include wound infection, urinary tract infection (UTI) excessive bleeding, scarring, blood blisters, swelling in the legs or groin, blood clots, changes to sexual function, altered sexual pleasure, changes in body image and incontinence. There may be the need for further surgery.



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Frequently Asked Questions

Vulvectomy surgery itself is not painful as it is carried out under a general anaesthetic. This means you will be asleep for the duration of the surgery. You will be prescribed painkillers to alleviate any pain and discomfort during the recovery period.

As part of your treatment with the Cadogan Clinic, you will have access to 24/7 on-call nurse assistance for the duration of your recovery.

It can take up to six to eight weeks for the stitches to dissolve after vulvectomy. It is important to wear loose fitting clothing to avoid irritating the area and to keep the stitches clean and dry in the aftermath of surgery.

Yes, it is possible to get a vulvectomy on the NHS. However the NHS has been, and continues to be, hit hard by the Covid-19 pandemic. High levels of staff sickness have had an impact on waiting times across the board. These waiting times vary from hospital to hospital. And any new waves of Covid-19 infections may result in this wait getting even longer. Because of this, many people choose to go to a private clinic for their vulvectomy. At the Cadogan Clinic, there is no waiting list, so you can have the procedure promptly.


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