What is pelvic exenteration?

Pelvic exenteration is an operation (surgery) to remove multiple organs in the pelvis. The internal reproductive organs (the ovaries, womb, cervix and vagina) are removed.

Depending on the type of pelvic exenteration the surgeon may also remove:

  • the bladder
  • part of the lower bowel (rectum)
  • both the bladder and the rectum.

The operation is sometimes called pelvic clearance.

We have more information about types of pelvic exenteration.

Before the operation you will be referred to a specialist cancer nurse. They will give you information and emotional support.

This operation can be done to treat cancers in the pelvis, including:

It can be used when cancer has spread within the pelvis, or has come back in the pelvis after other treatment. Pelvic exenteration is most often used to treat cervical cancer that has come back after treatment.

Pelvic exenteration can cure cancer in some people. But it is a major operation. It is important to discuss the benefits and risks with your surgeon, before deciding (consenting) to have it.

Before having pelvic exenteration

Pelvic exenteration is a major operation. It is only suitable for a small number of people. Together, you and your healthcare team will decide whether the operation is right for you. As part of this process you will:

  • have tests to check you can cope with the operation
  • talk to your healthcare team about any concerns you have.

If you consent to have the operation, you will go to a specialist centre to meet with a team of specialists involved in your care.

We have more information about what happens before this operation.

Having pelvic exenteration

Pelvic exenteration usually takes about 8 hours, but it can take longer. Two or more surgeons will work together. These could include:

  • a urologist – a surgeon who specialises in the urinary system
  • a colorectal surgeon – a surgeon who specialises in bowel cancers
  • a plastic surgeon – a surgeon who specialises in reconstruction.

Depending on the type of pelvic exenteration you have, you may have a urostomy, a colostomy, or both. Some women may also choose to have a new vagina made (vaginal reconstruction).

After having pelvic exenteration

After your operation you will be in an intensive care or high-dependency unit for the first few days. You will probably stay in hospital for 2 to 3 weeks.

When you wake up after the operation, you will have dressings on your wounds from the surgery. You may also have drips and drains. 

Getting moving

Your nurse or physiotherapist will encourage you to start moving around after the operation. A physiotherapist will show you gentle exercises and give you advice.

Stoma care

After a few days, you will be able to start to care for your own stoma and change the bag. Your stoma nurse will give you information and support to help you adjust.

Going home

When you go home, you will need extra help and support for a few weeks. Before your surgery, tell the hospital staff or your specialist nurse if you are worried about managing at home . They can arrange help for you.

When you go home you will have injections to thin the blood and reduce the risk of blood clots.

You may find it takes several months after surgery to recover. As time goes on, you will start to feel stronger and have more energy.

We have more information about what happens after pelvic exenteration.

Your sex life after having pelvic exenteration

The physical changes to your body after the operation (surgery) can mean changes to your sex life. How the operation affects you physically and emotionally will vary. You may need to make some adjustments. Your surgeon and specialist nurse will talk to you about the changes you may have. It can help to talk about any questions or worries you have.

We have more information about:

You may not feel like having sex for a while. If you have a partner, you may both need time to get used to any changes. There are different ways you can show your partner you care about them. This can include spending time together and showing affection through touching, holding hands or putting an arm around their shoulder. You may also find new ways to share sexual pleasure.

Although the vagina is often removed during pelvic exenteration, the clitoris usually remains. This means you may still have pleasure or orgasms from this area.

After treatment, you may find that your sex life slowly improves. If you continue to have difficulties, ask your specialist nurse or doctor for advice. They can refer you for more specialised support if needed.

Fertility after pelvic exenteration

As part of pelvic exenteration, your surgeon will remove your reproductive organs. This means that you will not be able become pregnant or have children. If you have not been through the menopause, it will start after pelvic exenteration. Your doctor or a menopause specialist should support you. They will talk to you about how to manage menopausal symptoms.

You can ask to be referred to a fertility specialist before having cancer treatment. You may be able to store your eggs or embryos (fertilised eggs) and use a surrogate in the future. This means that another woman will carry the child in her womb for you. Or you may want to consider adoption in the future.

We have more information about fertility in women.

Your feelings after pelvic exenteration

You may have many different emotions about pelvic exenteration. This can include stress, anger, anxiety and fear.

You may also find it difficult to cope with needing help from others while you are recovering. These are all normal feelings. They are part of adjusting. Talking about how you feel can help.

Sometimes it is easier to talk to someone who does not know you. You could ask your cancer doctor or GP to refer you to a counsellor.

Where to get help and support

As well as the support available from Macmillan, there are other organisations that can offer you practical and emotional support

  • Colostomy UK

    Colostomy UK provides practical help, support and reassurance to people who have or are about to have a colostomy, their carers, friends, and families.

  • IA – Ileostomy and Internal Pouch Association

    IA – Ileostomy and Internal Pouch Association offers support to help anyone who has had, or is about to have, their colon removed and has an ileostomy or internal pouch.

  • Urostomy Association

    Urostomy Association offers support and advice to anyone who has had, or is about to have, surgery resulting in a urostomy. Also offers support for families and carers.

  • Jo’s Trust

    Jo’s Trust provides information and support for women affected by cervical cancer and their families.

  • Eve Appeal

    Eve Appeal supports women affected by gynaecological cancers, and their family and friends.

  • Bowel Cancer UK

    Bowel Cancer UK offers information and support to people affected by bowel cancer.

  • The HPV and Anal Cancer Foundation

    The HPV and Anal Cancer Foundation provides support and information for people having treatment for anal cancer, and their carers and families.

  • LGBT Foundation

    LGBT Foundation provides advice, support and information to people who are gay, lesbian, bisexual or transgender, and their families and friends.

  • Stonewall

    Stonewall provides information and support to the LGBT community.

  • College of Sexual and Relationship Therapists

    College of Sexual and Relationship Therapists has a directory of sex and relationship therapists.

  • Human Fertilisation and Embryology Authority

    Human Fertilisation and Embryology Authority provides free impartial information to people affected by fertility treatment. Has information about choosing a clinic.

  • Fertility Friends

    Fertility Friends is an online community for people coping with infertility or adoption.

  • Fertility Network UK

    Fertility Network UK provides support for anyone with fertility problems.

  • Daisy Network

    Daisy Network provides information and support to women with premature menopause, including information on treatment and research and an online ‘network’.