Pelvic exenteration for women

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:

• cervical cancer
• womb cancer
• vaginal cancer
• vulval cancer
• rectal cancer
• anal cancer.

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.

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).

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:

• cancer and your sex life, including tips on talking to your healthcare team and coping with your feelings.
• female pelvic changes and sex. This includes changes in sensation, bladder problems and changes to the anus or rectum.
• sex and side effects of cancer treatment, which includes coping with a stoma.
• body image if you are worried about changes to your appearance.

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.

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.