Definition and Overview

Vulvectomy is a surgery to remove a part or the entire vulva, the female external genitals, to treat vulvar cancer.

The vulva is composed of the:

  • Vagina, which connects the vulva to the cervix and serves as a passage during childbirth. The cervix, on the other hand, links the vagina to the uterus or womb.
  • Clitoris, a small projection that is considered to be the most sensitive part. It is mainly used to increase pleasure during sexual stimulation or intercourse.
  • Labia, which refers to the genital’s inner and outer lips
  • Opening of the urethra, where urine comes out
    Vulva removal may be either simple, wherein either the side or upper or lower part of the vulva is taken away, or complete. Both may require the dissection of lymph nodes in the groin area if the reason for the procedure is cancer treatment.

Who Should Undergo and Expected Results

Vulvectomy is usually one of the treatment options for patients diagnosed with vulvar cancer. A rare type of cancer, it is characterised by the presence of lesions in any part of the vulva.

Although the actual cause of vulvar cancer has not yet been identified, it has many risk factors including the presence of human papillomavirus (HPV) infection, which also increases the possibility of cervical cancer, genital herpes infection, and vulval intraepithelial neoplasia (VIN), which is a pre-cancerous stage.

It may also be performed to correct congenital abnormalities, if any or all of the parts are injured, or the tissues have become necrotic. One of the major controversies involving vulvectomy is female genital mutilation (FMG), which is the removal of the clitoris and other parts of the vulva, on young women as a way of discouraging them from engaging in sexual intercourse or reducing pleasure during sex. The old practice is strongly condemned by many human rights groups and the World Health Organization.

As part of a cancer treatment, vulvectomy has a bigger chance of success if it’s done while the disease is still in the earliest stages wherein cancer cells in the lymph nodes have not yet developed. However, like other kinds of cancer therapies, it doesn’t completely prevent the disease from recurring or metastasizing to other genital organs like the cervix or the uterus.

How Does the Procedure Work?

If the vulva removal is for cancer treatment, the kind of surgery to be performed will depend on where the cancer is found, the health of the patient, cancer stage, expected outcome, and risks and complications.

The surgeon usually carries it out in a two-step process. He begins by dissecting the lymph nodes in the groin area to check for any presence of cancer. The surgery can be stopped and reevaluated, including other possible treatments like radiotherapy or chemotherapy, if the result is positive.

In the actual surgery, the surgeon uses different instruments, including a scalpel, to remove the area where the lesion is found. He also takes along with it a part of a tissue, which is then used to check for cancer cells. The excision of tissues will continue until the lab result reveals no more presence of cancer.

Depending on the part that has been taken away, a catheter may be used for a couple of weeks to help the patient urinate while the surgical wounds are healing. The surgeon may also add a graft material to make the vaginal area appear as normal as possible.

If the cancer is already in the advanced stage, which means it has gone deeper into the tissues and the female reproductive area, vulva removal is followed by cervicectomy (removal of the cervix) or hysterectomy (removal of the uterus).

Possible Risks and Complications

Aside from usual surgical complications like infection, bleeding, pain, and discharges, the patient may also experience decreased sexual pleasure and mental stress.

References:

  • Niederhuber JE, et al., eds. Cancers of the cervix, vulva and vagina. In: Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Sept. 4, 2015.

  • Lentz GM, et al. Neoplastic diseases of the vulva. In: Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.clinicalkey.com. Accessed Sept. 4, 2015.

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