A vulvectomy is a surgical procedure in which all or part of the vulva, the external part of a female's genitalia, is removed. Women diagnosed with vulvar cancer may require surgery to remove the cancerous cells. Typically, patients will undergo radiation or chemotherapy prior to surgery to shrink the size of the tumor and reduce the need for extensive surgery.
There are several different types of vulvectomies, and which one is used depends on the size of the cancerous area, how advanced the cancer is, and how far it has spread. Only the top layer of skin is removed in a skinning vulvectomy. Though it is the least invasive procedure, skinning vulvectomies are rarely done because of the increased risk of leaving cancerous cells in the vulva.
A simple vulvectomy involves the complete removal of the vulva. This procedure is commonly performed on patients who have noninvasive vulvar cancer. If the cancer has not spread to the lymph nodes or surrounding tissues, a simple vulvectomy provides security that all or most of the cancerous cells and tissues have been removed.
Radical vulvectomies can be full or partial in nature. Partial vulvectomies include the removal of part of the vulva, including the deep tissue. A full, or complete, radical vulvectomy is the most invasive vulvectomy procedure. It involves the removal of the entire vulva, including the deep tissues and clitoris. Complete radical vulvectomy procedures are only done on the most advanced types of vulvar cancer, and a separate procedure to remove the lymph nodes in the groin may be done if the cancer has spread.
Reconstructive surgery is often needed for women who have undergone a vulvectomy. Skinning vulvectomies and some partial vulvectomy procedures may not need any reconstructive surgery, as these wounds often heal on their own. Skin grafts are often needed for procedures that are more extensive. Sometimes fatty tissue is moved from another area on the body along with the skin graft to replace the natural "padding" of the vulva.
As with any surgical procedure, vulvectomies do have some associated risks and possible complications. Women often complain of discomfort when wearing tight pants or riding a bicycle because of the lack of fatty tissue to protect the urethra and vaginal opening. Many women feel self-conscious about the vulva's change in appearance after surgery. When a large amount of skin and tissue is removed, the risk of infection or the failure of a skin graft is increased.
Rarely, serious complications can occur after vulvar surgery. Fluid-filled cysts may form near the wounds, and blood clots may form that can travel to the legs and cause serious circulatory problems. The risk of urinary tract infections is much higher post-vulvectomy due to the increased exposure of the urethra. Many women also experience sexual side effects including inability to achieve orgasm, or pain and discomfort during sex.