Before and after surgery for vulval cancer
Your surgeon will discuss your surgery and how you can prepare. We have information about getting support before and after surgery for vulval cancer.
About vulval cancer treatment
Vulval cancer is sometimes called vulvar cancer or cancer of the vulva. It can affect any part of the vulva. Your cancer doctor or specialist nurse will explain the different treatments.
We have more detailed information about how vulval cancer is treated and types of vulval cancer surgery.
Before vulva cancer surgery
You will usually go to a pre-assessment clinic a few days or weeks before your operation for vulval cancer. You will have tests to check you are fit for surgery and your general health. These may include blood tests and an electrocardiogram (ECG) to check your heart.
A member of the surgical team and a specialist nurse will explain the operation to you. Make sure you tell them if you have any questions or concerns about the operation.
You will also see the doctor who will give you the anaesthetic (the anaesthetist). They will talk to you about the anaesthetic and how to control your pain after the operation.
You will usually go to hospital on the day of your operation. Sometimes, you may go in the day before. Your doctor or nurse will tell you when you need to arrive at hospital.
You will be given elastic stockings (TED stockings) to wear during and after the operation. These prevent blood clots forming in your legs.
If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems and will help your wound to heal after the operation.
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After your operation
How quickly you recover will depend on the type of vulval cancer operation you have.
You will be advised to start moving around as soon as possible. While you are in bed, it is important to move your legs regularly and do deep breathing exercises. This is to help prevent chest infections and blood clots. A physiotherapist will show you how to do these exercises.
You may also have regular injections of a blood thinning drug to help reduce the risk of blood clots. You may need to continue the injections after you go home. Your nurse will teach you or a relative how to give the injections, or arrange for a district nurse to visit you at home.
If you have had lymph nodes removed from your groin, you should try to put your feet up when you are sitting down. This helps to reduce leg swelling.
Back on the ward
You will be given fluids into a vein in your hand or arm. This is called a drip or intravenous infusion. It will be taken out when you are eating and drinking again.
You usually have a tube called a catheter that drains urine from your bladder. This may be taken out a few hours after your surgery, or it may need to stay in for longer.
If your lymph nodes have been removed, you will have a drainage tube going into your groin. This is to remove fluid that may collect there. The drain is connected to a small suction bottle. Your nurse removes it from your groin when most of the excess fluid has drained off. This usually takes a few days. You can go home with the drain if needed. A practice nurse or a district nurse may check it when you are at home. Or you might have it checked and removed at the hospital.
Pain
It is normal to have some pain or discomfort for a few days after surgery. Painkillers can help with this. It is important to let your doctor or nurse know as soon as possible if the pain is not controlled. They may need to change your painkillers.
Immediately after your operation you may have strong painkillers in one of the following ways:
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By injection into a muscle
The nurses will do this for you as needed.
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An epidural
This is a small, thin tube in your back that goes into the space around your spinal cord. An epidural will give you continuous pain relief
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A patient-controlled analgesia pump (PCA pump)
This pump is attached to a fine tube (cannula), in a vein in your arm. You control the pump using a button that you press when you need more of the painkiller. It is fine to press the handset whenever you have pain. The pump will not let you give yourself too much painkiller.
When you no longer need strong painkillers, you will get painkillers as tablets. You may get a supply to take home with you. Tell your nurse or doctor if you are still in pain, so they can change the dose or the type of painkiller.
Your wound
The nurses will help you look after your wounds in hospital and give you advice about caring for your wounds at home.
Some people do not need a dressing on the vulval wound. The area is cleaned by gently rinsing with water and carefully drying. This usually happens at least once a day until you go home.
If you do have a dressing, your nurse will change it regularly and remove it after a few days.
If you have groin wounds, the dressings need to be changed regularly. Sometimes, wounds near the groin take longer to heal than wounds in other areas.
If you had a skin graft, you may have dressings on the area the skin was taken from (donor site). Usually these dressings stay on until new skin has grown. How long it takes to heal will depend on how much skin was removed. Your doctor or nurse can give you more information.
Sometimes vacuum-assisted (VAC®) therapy can help wounds heal. VAC® therapy uses a pump or suction machine attached to a dressing on your wound. It gently draws fluid out of the wound and helps with healing by encouraging blood flow to the affected area. VAC® therapy may be in hospital or managed at home by a district nurse.
Some types of stitches are left in place and dissolve away over time. If you do not have this type, your stitches or staples will be removed. Usually this is about 7 to 10 days after your operation. If you have had reconstruction surgery, your surgeon may leave them in longer.
Wound infections can happen after surgery. It is important to tell your nurse or doctor if you get any of these signs of infection, even after you go home:
- the wound feels hot or swollen
- the wound looks red
- discharge (fluid or pus) is coming from the wound
- you feel unwell
- you have a fever or high temperature.
Constipation
It is normal not to have bowel movements for a few days after your operation. The operation, your painkillers and changes to your diet and activity levels can cause this. Your doctor may give you laxatives to prevent constipation. If bowel movements are painful or difficult, tell your doctor. They can give you extra laxatives to help.
How your vulva looks
If you have never looked at your vulva before, the idea of doing so may seem strange. It is okay not to look at all. It is also natural to want to know how things have changed after surgery.
To start with, you will have some bruising and swelling around the vulva. This should slowly get better as you recover from surgery. Some types of surgery will change how the vulva looks long term. A nurse can explain what to expect and give you support and advice.
You may want to be by yourself when you look for the first time. Or you might want a nurse, partner, relative or close friend with you. Whoever you choose, make sure it is someone that you trust and can talk to about your feelings.
You may prefer to look alone or with a nurse, partner, relative or close friend. Whoever you choose, make sure it is someone that you trust and can talk to about your feelings.
Do not force yourself to look before you feel ready. Remember that you may feel shocked, even if you are well prepared. People cope with changes in appearance differently. They do not upset some people. Others find these changes harder to cope with.
Going home from hospital
When you go home, you will not be able to do a lot straight away. You will need to rest for a few weeks. But it is important to keep moving. How long it takes you to recover will depend on the type of surgery you had.
If you had major surgery, it is very important not to lift any heavy objects for at least 6 to 8 weeks. This will let the skin heal completely.
If you had lymph nodes removed from the groin you may find some movements uncomfortable, such as walking or getting into a bath. This is normal and will get easier as your wounds heal.
You can usually start driving after about 6 weeks. Always check with your doctor or nurse and car insurance provider before driving. They may want you to wait longer before you drive again.
If your operation involved removing only a small amount of skin, your recovery will be much quicker. Your doctor will tell you what to expect and how to look after yourself. Here are some helpful tips:
- Wear loose-fitting clothing and clothing made from cotton rather than synthetic material.
- Avoid using any lotions, perfumes and talcum powders in the area where you had your operation.
- Take short walks but avoid doing a lot of walking until the skin has healed.
- Keep your wound clean. You could rinse the area with a hand-held shower. Or you may find it easier to use something called a sitz bath. This is a small basin that fits over the toilet. This lets you soak just your buttocks and genital area. If you cannot get a sitz bath locally, you can buy one online.
- Keep your wound dry. Try using a hairdryer on a cool setting to dry the vulval skin. Or gently pat your skin dry with a clean towel.
- If passing urine makes your wound sting, try pouring a small jug of lukewarm water over the wound while you are sitting on the toilet.
- Some people will need to wear underwear to hold pads or dressings in place. But if you can avoid wearing underwear, this may feel more comfortable.
- If you are constipated, ask your doctor for laxatives.
Before you leave hospital, your team may arrange for a district nurse to visit you at home. They can also organise other support services if you need them. If you need help with a wound or a wound drain, the district nurses can visit you at home to help with this.
Sex
Your surgeon will usually advise not to have sex for at least 6 weeks after your operation. This gives your wound time to heal properly. After that most people will be able to gradually get back to their usual sex life. You may need time before you feel ready, especially if you are having other treatments as well.
A few people may develop tightening and scar tissue at the entrance to the vagina. This can make sex painful and difficult. It is important to talk to your doctor or nurse if this happens. They can give you advice and support. They may give you vaginal dilators to reduce tightening.
If the clitoris was removed at the time of surgery, sex can feel different. It may be more difficult to orgasm. Your doctor or nurse will discuss this with you before the operation.
Bladder and bowel problems after surgery
Surgery for vulval cancer does not usually cause long term bladder or bowel problems.
If part of the vulva is removed, the stream of urine may flow to one side or spray. This may feel a little odd the first few times you pass urine.
Rarely, surgery involves removing part of the tube that you pass urine through (urethra) or the lowest end of the bowel (anus and rectum). This may affect how you pass urine or have a bowel movement. Your doctor or nurse will discuss this with you before the operation.
Nerve damage
Sometimes surgery affects the nerves and causes numbness, tingling or pins and needles in the area around the vulva. It can also cause a change in sensation in your groin or down your legs. This usually improves over the months after surgery. Sometimes it is permanent.
Follow-up
At your follow-up appointment, your surgeon will check how you are recovering from the operation. They will also give you information about any further treatment you may need, such as radiotherapy or chemotherapy.
If you have any problems or worries before this follow-up appointment, contact your hospital doctor or nurses for advice.
Getting support
It is common to feel upset and tearful after the operation. This is often a reaction to:
- the diagnosis of cancer
- having the operation
- being away from your usual support network.
These feelings may go after a few days, or you may continue to feel this way. Tell your doctor or specialist nurse if you are not feeling better or if you begin to feel very low. You may need extra help and support.
Some hospitals have local support groups for people who have gynaecological cancers. If you think you would find a support group helpful, ask your nurse specialist if there is one in your hospital or local area.
You may want to talk about your feelings with an organisation that specialises in vulval cancer. You could also join an online support group such as our Online Community. You can chat with other people who have vulval cancer. Or you can just read the posts or blogs other people have written.
About our information
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References
Below is a sample of the sources used in our vulval cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Morrison J, Baldwin P, Buckley L, et al. Gynaecological Cancer Society (BGCS) vulval cancer guidelines: recommendations for practice. 2020 [accessed November 2020].
Rogers LJ, and Cuello MA. Cancer of the vulva. Int J Gynaecol Obstet, 2018; 143, S2, 4-13. Available from https://doi.org/10.1002/ijgo.12609. [accessed November 2020].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Nick Reed, Consultant Clinical Oncologist.
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
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