Vulval surgery

Vulval surgery may include removal:

• of some or all of the vulval tissue
• of lymph nodes in one or both groins — this is because vulval cancer can spread to these nodes.

Your surgeon may use diagrams to help explain the procedure.

Talk to your surgeon about:

• the benefits of surgery for your condition.
  Other treatment options that may be available.
  Possible risks and side effects.
  Any long-term changes to your lifestyle after surgery.

Vulval surgery has potential risks, including:

• infection
• blood clots (deep vein thrombosis or DVT)
• swelling in the legs (lymphedema)
• fluid buildup in the groin (lymphocysts)
• changes to how you feel during sex
• difficulty having a wee.

Your surgeon will discuss these risks with you before surgery. If the surgery involves removing the clitoris and surrounding tissues, your surgeon will explain how this may affect sensation and having sex.

Before your surgery, you will have:

•  a consultation with a doctor, nurse, and anaesthetist
• blood tests, a urine sample (if needed), a chest x-ray, and an ECG (heart tracing)
• information about your surgery and hospital stay will be provided to you
• a review of any medications you take, including herbal and over-the-counter medicines
• confirmation of your surgery date.

Before surgery

• A nurse will prepare you for surgery.
• You will meet with your surgeon and anesthetist.
• You will sign consent forms.

After surgery

You will have:

• oxygen through a mask or nasal prongs
• a catheter to drain urine
• dressings on your surgical wounds
• stitches in the vulval area that will dissolve over time
• an intravenous (IV) line for fluids, which will be removed once you can drink normally
• pain relief through a controlled pump or oral medication.

You may also have:a drain in the groin area to remove excess fluid. This may stay in place for up to 7 days.

Mobility

• At first, you will need to keep your upper body at a 45 degree angle to reduce swelling.
• You may need to stay in bed for up to 48 hours.
• A physiotherapist will help with breathing exercises and leg movements to prevent complications.
• You will have help when you start walking again.

Bowel care

• To prevent constipation, you will be given a gentle laxative.

Blood clot prevention

• You will receive daily injections to thin your blood and prevent clots.
• You will wear special stockings until you are discharged.

Drainage tubes

• Drains in your groin help remove excess fluid.
• These are removed once the drainage slows, which varies for each person.

Lymphedema

• This is swelling in the legs due to the removal of lymph nodes.
• A specialist physiotherapist will provide guidance and information.

Lymphocysts

• These are fluid collections in the groin that sometimes occur after drains are removed.
• They may drain on their own or require medical intervention.

Passing urine

• You may have difficulty having a wee after the catheter is removed.
• Your nurse will help you if this occurs.

You may find that it takes time to adjust to any changes to your body and how you feel about sex. Talk to your healthcare provider if you need support.

You will be able to go home when you can manage your wound care yourself or with help from a district nurse or your healthcare provider.

If you need extra support at home, this will be arranged before you leave.

• You will have a follow-up appointment.
• Avoid long flights soon after surgery to reduce the risk of complications.

• Keep the vulval area clean and dry.
• Use a handheld shower.
• Only use water — avoid soaps or creams unless prescribed.
• Pat dry gently and do not rub.
• Wash after having a poo.
• Apply any ointments you have been prescribed as directed.
• Use sanitary pads instead of tampons until you are fully healed.
• Avoid swimming pools, spa pools, and the sea until cleared by your surgeon.

Contact your healthcare provider if you have:

• flu-like symptoms or a fever
• pain or difficulty when having a wee
• heavy bleeding or a smelly discharge
• redness, pain, or increased discharge from your wound.

• You will need at least 6 weeks off work.
• If you need a medical certificate this will be provided.
• A physiotherapist will help you gradually increase activity to support your recovery.