Before and after surgery for vulval cancer

If you smoke, try to stop or smoke less before your operation. This will help reduce your risk of chest problems. It will also help your wound heal after the operation. Your GP can help you if you want to stop smoking.

You usually go to a pre-assessment clinic a few days or weeks before the operation. You will have tests to check that you are fit for surgery. 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 have an appointment with the doctor who will give you the anaesthetic. They are called an anaesthetist. They will talk to you about the anaesthetic and how to control your pain after the operation.

You usually go to hospital on the day of your operation. Sometimes, you may go the day before. Your doctor or nurse will tell you when you need to arrive.

You will be given elastic stockings to wear during and after the operation. These are called TED stockings. They prevent blood clots forming in your legs.

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 depends on the type of operation 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. This may include walking or getting into a bath. This is normal and will get easier as your wounds heal.

You can usually start driving about 6 weeks after the operation. Always check with your cancer doctor or specialist 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 for coping after surgery to the vulval area:

Keep your wound clean. You could rinse the area with a handheld 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.
• 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.
• Avoid using any lotions, perfumed products and talcum powders in the area where you had your operation.
• 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.
• Wear loose-fitting clothing made from cotton rather than synthetic material.
• 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.
• Take short walks, but avoid doing a lot of walking until the skin has healed.

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 community nurses can visit you at home.

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. But you may need more time before you feel ready, especially if you are having other treatments as well.

Some 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 cancer doctor or specialist nurse if this happens. They can give you advice and support. They may suggest using lubrication to help. They may also give you vaginal dilators to reduce tightening. Dilators are tampon-shaped plastic tubes of different sizes. You can use these regularly inside the vagina with a lubricant, to gently push the walls of the vagina apart. Your cancer team will explain how to use them safely.

Treatment may have changed the way your genital area looks or feels. If the clitoris was removed at the time of surgery, sex can feel different. It may be more difficult to orgasm. Your cancer doctor or specialist nurse will talk to you about this before the operation.

It can be helpful to speak to a sex therapist. This is a healthcare professional who is trained to support people with sexual problems. They offer advice and exercises that may help. Your GP, cancer doctor or specialist nurse should be able to refer you to a sex therapist.

The College of Sexual and Relationship Therapists (COSRT) also has a list of nationwide counsellors and therapists who can offer advice and support.

We have more information about sex and cancer.

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 spray or flow to one side. This may feel a little odd the first few times you pass urine. This also may happen if you have the lower part of the urethra removed – this is the tube that you pass urine through.

Sometimes, if you have the lowest end of the bowel (anus and rectum) removed, this may affect how you have a bowel movement. Your doctor or nurse will talk to you about any possible side effects before the operation.

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 the groin or down the legs. This usually improves in the months after surgery. Sometimes it is permanent.

After vulval cancer treatment, some people may develop lymphoedema. Lymphoedema is swelling that develops because of a build-up of lymph fluid in the body’s tissues. The lymph nodes are part of the body’s immune system and help fight infection. A fluid called lymph fluid normally flows through these nodes.

Lymphoedema may develop if the nodes are removed during surgery. Fluid may collect and cause swelling in one or both legs, or the pubic area.

Pelvic radiotherapy may also increase the risk of lymphoedema. The risk is higher if you have surgery to remove the lymph nodes as well as radiotherapy.

Not everyone gets lymphoedema after treatment for cancer of the vulva. But it can start months or years later.

There are treatments that help manage swelling. There are also things you can do to reduce your risk of getting lymphoedema. Your doctor or nurse may plan for you to meet with a specialist for advice.

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 some time, or you may continue to feel this way. Tell your cancer doctor, specialist nurse or GP 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 specialist nurse 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. Or you can talk to one of our cancer support specialists on 0808 808 00 00.