You will usually go to a pre-assessment clinic a few days or weeks before the operation for vulval cancer.
You will have tests to check you are fit for surgery, such as 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 discuss any questions or concerns that you have about the operation with them.
You will also see the doctor who will give you your anaesthetic (the anaesthetist). They will talk to you about the anaesthetic and explain how your pain will be controlled after the operation.
You will usually be admitted to hospital on the day of your operation. Sometimes, you may be admitted 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. Your GP can help you if you want to give up smoking
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How quickly you recover will depend on the type of operation you have. You will be encouraged 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 will be encouraged 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 (IV) infusion. This will be taken out as soon as you are eating and drinking normally.
You will usually have a tube (catheter) to drain urine from your bladder. It is usually taken out a few days after your surgery, but sometimes 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 any fluid that may collect there. The drain is connected to a small suction bottle.
Your nurse will remove it from your groin when most of the excess fluid has been drained off – this usually takes a few days. If needed, you can go home with the drain.
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.
It is normal to have some pain or discomfort for a few days after surgery. But this can be controlled with painkillers. It is important to let your doctor or nurse know as soon as possible if the pain is not controlled, so that they can change your painkillers.
Immediately after your operation you may have strong painkillers. You may be given painkillers through one of the following:
By injection into a muscle
The nurses will do this for you.
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.
A patient-controlled analgesia pump (PCA pump)
The pump is attached to a fine tube (cannula), in a vein in your arm. You control the pump using a handset that you press when you need more of the painkiller. It is fine to press the handset whenever you have pain. The pump is designed so that you cannot give yourself too much painkiller.
When you no longer need strong painkillers, you will be given milder painkillers as tablets. You may be given a supply to take home. Tell your nurse or doctor if you are still in pain, so they can adjust the dose or give you a different painkiller.
You may not have any dressings on your vulval wound. The area is likely to be kept clean by being gently rinsed with water and carefully dried. This is usually done three times a day until you go home.
If you do have a dressing, your nurse will remove it after a few days and change it regularly, to keep the area clean and help the skin to heal.
If you have any wounds in your groin area, they will be covered with dressings, which will need to be changed regularly. Sometimes, wounds near the groin can heal more slowly than wounds in other areas.
You may have vacuum-assisted (VAC®) therapy. VAC therapy uses a pump or suction machine, which is attached to a dressing on your wound. It draws fluid out of the wound and helps with healing by encouraging blood flow to the affected area. This can be done in hospital or managed at home by a district nurse.
If you do not have stitches that dissolve, your stitches or staples will probably be removed about 7 to 10 days after your operation.
If you have had a skin graft, you may need dressings on the area the skin was taken from (donor site). Usually these dressings stay in place until new skin has formed. How long the site takes to heal will depend on how much skin was removed. Your doctor or nurse will explain more about this to you.
Wound infections can be a complication of the surgery. Signs of wound infection include:
- discharge (fluid or pus coming from the wound)
- feeling unwell
- a fever or high temperature.
Tell your nurse or doctor if you get any of these symptoms, even after you go home.
You may not have bowel movements for a few days after your operation. This is normal and may be due to the combined effects of the operation, painkillers and changes to your diet and activity levels.
You may be prescribed laxatives to prevent constipation. If opening your bowels is painful or difficult, let your doctors know so they can prescribe extra laxatives to help.
How your vulva looks
After surgery, you will have some bruising and swelling around your vulva. This should gradually disappear with time.
Some types of vulval surgery can change the appearance of your genital area. How you approach looking at the vulval area after your operation will be very personal to you. If you have never looked at your vulva before, the idea of doing so may seem strange.
You may not want to look at the area at all, or you may want someone with you when you look for the first time. A nurse can explain what has happened to the area and give you support and advice.
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 do things before you feel ready. If you decide to look at the area where you had surgery, remember that you may feel shocked, even if you were well prepared. This is understandable. People cope with changes in appearance differently. Some people may not be very upset by them. Others find these changes harder to cope with.
When you go home, you will not be able to do a lot straight away. But it is important to keep moving. You will need to rest for a few weeks. How long it takes you to recover will depend on the operation you have had.
If you have had major surgery, it is very important not to lift any heavy objects for at least six to eight weeks. This will help the skin to heal completely.
If you have had lymph nodes removed from your groin you may find some movement uncomfortable, such as walking or getting into a bath. This is normal and it will get easier as the wounds heal.
You can usually start driving after about six weeks, but you should check with your doctor or nurse and car insurance provider first. 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 advise you on what to expect and the precautions you should take. Here are some other helpful tips:
- Avoid wearing tight clothing or clothing made from synthetic materials – cotton is better. You may find loose-fitting skirts comfortable.
- Avoid using any lotions, perfumes and talcum powders in the area where you had your operation.
- Avoid doing a lot of walking until the skin has healed. Short walks are better.
- Keeping your wound clean and dry is important. You could rinse the area with a hand-held shower. Some women find it easier to use a ‘sitz bath’ (a type of bath that fits over the toilet and allows you to soak just your buttocks and genital area). If you cannot get a sitz bath locally, you can buy one online.
- If passing urine makes your wound sting, try pouring a small jug of warm or tepid water over the wound while you are still sitting on the toilet.
- A hairdryer on a cool setting can be a comfortable way of drying the vulval skin. You can also try gently patting your skin dry with a clean towel.
- If you can avoid wearing underwear, this may help to keep you more comfortable. However, it won’t be possible if you have to keep pads in place.
- If you become constipated, ask your doctor to prescribe you some laxatives.
Before you leave hospital, the staff can 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.
Your surgeon will usually advise you not to have sex for at least six weeks after your operation. This is to give your wound time to heal properly.
After that most women will be able to gradually get back to your usual sex life. But it is not unusual to need more time before you feel ready, especially if you are having other treatments as well.
A few women may develop some tightening and scar tissue at the entrance to the vagina, which can make sex more difficult. If this happens, it is important to discuss it with your doctor or nurse. They can give you advice and support.
If the clitoris was removed at the time of surgery, sex can feel different and it can be more difficult to become aroused. Your doctor or nurse will discuss this with you before the operation.
Bladder and bowel problems after surgery
Most women who have surgery for vulval cancer will not have any problems with their bladder or bowel.
Sometimes when part of the vulva has been 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, if the cancer has spread to the tube that you pass urine through (urethra) or the lower end of the large bowel (anus and rectum) these areas will be included in the operation. This may affect how you pass urine or have a bowel movement. Your doctor or nurse will discuss this with you before the operation.
After surgery, some women have numbness, tingling or pins and needles in the area around the vulva. You may also have a change in sensation in your groin or down your legs. This is because of the effects of surgery on the nerves close by.
These effects usually improve over a period of months, although for some women they can be permanent.
At your follow-up appointment, your surgeon will check how you are healing and ask how you have been recovering after the operation.
They will also discuss the results of the operation with you and advise you if you need any further treatment.
If you have any problems or worries before this follow-up appointment, contact your hospital doctor, nurse specialist or the nurses on your ward for advice.
It is common to feel upset and tearful after the operation. This can be a natural reaction to the diagnosis of cancer, the effects of the operation and being away from home and family.
You may find these feelings go after a few days, or you may continue to feel this way after you go home.
Tell your doctor or specialist nurse if you are not feeling better or if you begin to feel very low, as you may need extra help and support.
Some hospitals have local support groups for women who have gynaecological cancers. If you think you would find a support group helpful, tell your nurse specialist. They can tell you if there is one in your hospital or local area.