Definition & Overview
Vaginectomy is a surgical procedure used to treat vaginal cancer or as a part of gender reassignment surgery. It can be partial or radical. It is radical if the whole vagina is removed, or partial if only the upper part of the organ is removed. Most of the time, it is performed with total abdominal hysterectomy.
Who Should Undergo and Expected Results
Vaginectomy can be recommended to patients diagnosed with:
- Vaginal cancer - Vaginectomy is used to remove cancer cells in the vagina. There are several types of vaginal cancer, classified according to the origins of cancer cells. These are:
- Vaginal squamous cell carcinoma, which originates from the squamous epithelium that lines the surface of this organ. This is the most common type of vaginal cancer.
- Vaginal melanoma, which arises from melanocytes, the cells responsible for pigmentation.
- Vaginal adenosarcoma, which begins from the glands located on the surface of the vagina.
- Vaginal sarcoma, which is due to the abnormal growth of connective tissues and muscles in the walls of the vagina.
All these types of vaginal cancer have similar symptoms. These include bleeding, abnormal and odorous discharge, the growth of tissue mass, pelvic pain, and pain during sexual intercourse and urination.
Severe lichen planus in the vulva and vagina – In such case, vaginectomy is considered as the last resort if topical treatments are not effective. Patients with this condition suffer from pain and soreness in the vaginal area. If left untreated, it could lead to labial adhesions and narrowing of the introitus.
Vaginal prolapse - This is a condition in which the uterine and part of the vagina descend because the tissues that support them have weakened. This displaces the organ resulting in patients having difficulty moving or holding their urine.
Benign tumour growth in the vagina.
The procedure is also a part of a gender reassignment surgery where the vagina is removed before a penis is surgically constructed.
Vaginectomy is a major surgery that requires hospitalisation. Its success in treating cancer patients depends on the extent of the disease. Patients with localised cancer with no indication of metastasis have better chances of complete cure. Many patients have expressed satisfaction over the results, especially if reconstructive surgery is also performed after the procedure.
Patients are advised to rest for several weeks after the surgery and to have scheduled check-ups with their physicians for monitoring. Strenuous physical activities and sexual intercourse are to be avoided for several weeks to facilitate healing. Patients are also encouraged to undergo physical therapy.
How is the Procedure Performed?
The procedure is performed under general anaesthesia. The patient is placed in the same position when a woman gives birth to expose the vaginal and perineum area. The surgeon then examines the whole pelvic area and inserts a catheter to the bladder. A long incision is made around the vagina, and the cut is deepened down to the pubocervical fascia. The surgeon then separates the mucosa from the lateral wall of the vagina. The pudendal artery is identified, clamped, and then tied off. The dissection of the vagina is continued under the urethra and bladder, taking care not to injure the numerous blood vessels in the area.
Another surgeon then performs total hysterectomy by making an incision in the abdominal area. The peritoneal cavity is accessed to locate the vagina and the bladder. The bladder is dissected from the vaginal wall. The surgeon continues the dissection to detach the vagina from the ureters, the cervix, and the rectum.
The whole vagina or a part of it is slowly removed, making sure to avoid injuring nearby parts. If needed, the surgeon will reconstruct the vaginal canal using tissue graft. In some cases, the vaginal canal is completely stitched closed if the patient is not sexually active anymore. Those who are sexually active can choose to undergo vaginoplasty after this procedure to surgically reconstruct the remaining tissue to resemble a normal vagina.
Possible Risks and Complications
As a major surgical procedure, vaginectomy is linked to various risks and possible complications. These include:
- Uncontrolled bleeding during and after surgery
- Infection, which could set in after the procedure. This infection could travel to the bloodstream, leading to a life-threatening condition called sepsis.
- Urinary fistula, which is characterised by the constant leaking of urine caused by an abnormal opening between the urinary bladder and the vagina.
- Rectal dysfunction. Some patients experience chronic leakage of faeces and gas that leads to considerable distress.
- Deep vein thrombosis, which is characterised by pain and tenderness in one or both legs.
There are also reports of groin pain, fever, and urinary tract injury following vaginectomy.
Weitzel HK, Jaluvka V, Opri F: [Colpohysterectomy: A contribution to gynecologic geriatric surgery]
Hohlweg-Majert VP, Pohl R, Heyl V: [Hysterocolpectomy: The method of choice in genital prolapse in geriatric patients] Hysterokolpectomie. Fortschr Med 104:21-22, 1986.