A vulvectomy is a medical procedure performed by a surgeon during which some or all portions of the vulva are removed. The purpose? To improve the individual’s overall current or future health status, as well as their quality of life.
Ahead, learn more about why vulvectomies are performed, the different types of vulvectomies people with vulvar cancer can choose from, and exactly how to prepare for and recover from the procedure.
Anatomy 101As a refresher, the vulva is the external portion of the genitals of people born with vaginas (people assigned female at birth). The vulva is made up of the labia majora, labia minora, clitoris, and urethra.
“A vulvectomy is a surgical procedure that can be done to treat genital cancer, precancer, or chronic skin conditions like lichen sclerosus in people with vulvas,” explains Alexis Parcells, MD, plastic surgeon and founder of SUNNIE skin care.
The surgery is done in order to remove diseased tissues on the infected portion of the vulva, which can include the inner and outer labia as well as the clitoris, she says.
Indeed, a vulvectomy is the most common procedure performed on people with vulvar cancer, according to Veena Madhankumar, MD, OB-GYN, of iCliniq, an online hospital that puts patients in touch with specialists virtually.
“A vulvectomy is also sometimes performed on individuals with severe sweat gland diseases,” adds Madhankumar.
Vulvectomy vs. labiaplasty
Routinely viewed as a cosmetic procedure, a labiaplasty involves removing what the patient and clinician dub as “excessive” labia minora tissue, explains Parcells.
Typically, this refers to labia minora tissue that extends past the labia majora tissue.
While the end result of a labiaplasty may be similar to the end result of a vulvectomy targeting the labia minora, the intent between the two is different.
“Vulvectomy is done in order to reduce the risk of disease or spread of cancer,” says Parcells. “Labiaplasties, on the other hand, are done in order to relieve chafing, swelling, and generalized discomfort, as well as to improve the overall appearance of the vulva.”
There are a few different surgical procedures that are considered a vulvectomy. The main difference between them is how much of the vulvar tissue and surrounding lymph nodes are removed.
Skinning
Skinning is the least invasive vulvectomy variation. Here, the surgeon leaves most of the vulva intact, and instead removes the top layer of skin of the area of concern, explains Madhankumar.
Depending on how much skin is removed, a skin graft may be used to minimize the changes in the appearance of the vulva, she notes.
Simple
During a simple vulvectomy, the majority (or all) of the vulva is removed.
“Most commonly, a simple vulvectomy involves removal of the inner and outer labia, the clitoris, and the tissue just under the skin,” says Madhankumar.
In some cases, a surgeon will leave the clitoris if it isn’t negatively impacted by the condition.
Partial or modified
This kind of vulvectomy involves removing the majority of the external vulvar tissues, as well as some of the deep tissues and lymph nodes underneath it, says Madhankumar.
Complete radical
The most extreme variation of a vulvectomy, a complete radical vulvectomy, is also the rarest.
“This procedure is done to remove the entire vulva which includes the clitoris, vaginal lips, and the opening to the vagina and nearby lymph nodes,” explains Madhankumar.
Curious if you’re a good candidate for a vulvectomy? That’s something for you and a healthcare professional to decide.
You could be a good candidate if you have any of the following conditions:
- vulvar intraepithelial neoplasia, a precancerous condition
- vulvar cancer, including vulvar squamous cell carcinoma and vulvar melanoma
- lichen sclerosis, a skin condition that causes thin, white patches around your genitals
- vulvar psoriasis, a skin condition that causes tight, red patches around your genitals
- vulvar eczema, a skin condition that causes itchy, red patches around your genitals
- a disorder affecting vulvar sweat glands, such as Fox–Fordyce disease
As is the case with any kind of surgery, before a vulvectomy, you’ll undergo a complete and total health check.
“There’s some blood work that will need to be done before surgery,” says Madhankumar. “Certain medications will need to be stopped before surgery, too.”
Beyond that, your surgeon may also request that you limit or avoid:
- smoking cigarettes, vaping nicotine, or using other tobacco products
- smoking, vaping, or otherwise using cannabis and other drugs
- drinking alcohol
- taking herbal supplements or tinctures
If you’ve been through menopause, your clinician may prescribe a topical estrogen cream to help make your skin more supple ahead of the procedure.
You may also choose to wax or shave your pubic hair before surgery. If your pubic hair hasn’t been removed before the day of your surgery, it will be removed for you by your clinician.
On the day of surgery, you should avoid wearing makeup, lotion, deodorant, nail polish, antiperspirant, and jewelry, she adds. Wear or bring loose-fitting clothing and cotton underwear to change into afterward.
Ultimately, what takes place during a vulvectomy will vary based on the type of procedure you receive.
Here’s a general outline of procedure day:
After you arrive at the hospital, fill out the requisite paperwork, and put on your gown, you’ll be led (or rolled) into the operating room.
There, a clinician may ask you to put on a pair of compression socks to help lower the risk of blood clots.
Next, you’ll either be given general or spinal anesthesia. Spinal anesthesia numbs your vulva, as well as the other body parts below your waist. The type of anesthetic you receive will depend on your individual health history and preferences.
During surgery, a tube (known as a Foley catheter) will be placed into your urethra to monitor the amount of urine that’s coming out.
Finally, the surgeon will clean the area and remove the affected tissues. They’ll also remove a portion of healthy tissues around the area to ensure that all of the affected tissues or (pre)cancerous cells are removed.
If a skin graft is needed, your surgeon will remove a piece of healthy tissue from elsewhere on your body (usually the forearm or thigh) and stitch it over the places between your legs that were cut into.
When you wake up from surgery, your genitals will be covered with a dressing designed to protect the area. You’ll also be wearing a catheter as well as compression socks.
To be clear: A vulvectomy is a serious procedure. Healing typically takes 2 to 3 weeks.
You’ll likely be prescribed pain relieving medication, as well as a stool softener to make passing bowel movements easier.
Whether you’re encouraged to walk about while you’re healing will vary from person to person. Some people may be told to keep their legs together as much as possible, while others may be told to walk in order to support their recovery.
“Sexual intercourse should be avoided for about 6 to 8 weeks after vulvectomy,” says Madhankumar. “The doctor will let you know when to have sexual intercourse again.”
This goes for all sexual activity involving your genitals, anus, or positions that could compromise your healing.
You’ll likely have one or multiple follow-up appointments with your clinician 1 to 8 weeks after your surgery.
As with other major procedures, there are a few potential risks.
According to Madhankumar, these include:
- unusual vaginal odor or discharge, which could be a symptom of infection
- fever or chills
- vaginal bleeding or spotting
- swelling in the lower extremities
- urinary incontinence
- urinary tract infection
- changes in libido or sexual function
You may be more likely to experience these effects up to 8 weeks after the procedure.
Changes in libido or sexual function may develop or persist beyond this time frame. However, more research is needed to better understand these results.
Yes.
Vulvar reconstruction is often done at the same time as vulvectomy by way of well-placed stitching and skin grafts.
However, people who needed more extensive surgery may require a second appointment for reconstructive work.
It depends on why you’re considering a vulvectomy.
“The treatment options for vulvar cancer depend on its severity and extent, but the best treatment for vulvar cancer is vulvectomy,” explains Madhankumar.
However, according to the National Health Service, radiation and chemotherapy are also options. Some people with vulvar cancer undergo a combination of all three.
If you’re considering a vulvectomy because you have a lymph node, sweat, or skin condition, you might be a better candidate for one of the below treatments:
- topical steroid cream, which can help lower inflammation
- intravenous (IV) steroids or steroid injections, which may provide relief for several months at a time
- pelvic exenteration, which is surgery to remove nearby lymph nodes
At its most distilled, a vulvectomy involves removing portions of your vulva in order to remove cancerous or unhealthy cells and tissues in your genital region.
If you’re experiencing any symptoms of vulvar cancer such as unexplained pelvic pain or tenderness, unexpected vaginal bleeding, or vaginal itching, it’s important to consult with a healthcare professional.
A clinician can take a closer look at the area and assess your symptoms. They may recommend testing for sexually transmitted infections, bacterial vaginosis, or other health conditions to better understand the root cause and make a diagnosis.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.