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Vaginal reconstruction after pelvic exenteration | CION Cancer Clinics
When pelvic exenteration removes all or part of the vagina, many women can have a new one made from a flap of skin and muscle from the tummy or thighs, usually in the same operation. It feels different, needs a lubricant and must be kept open with a dilator. It is a choice, and declining is reasonable. This page explains the options, the aftercare and who it may not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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The short answer
Can the vagina be rebuilt after pelvic exenteration?
Yes, in many women it can. When exenteration removes all or part of the vagina, a surgeon can shape a new one from a flap of skin and muscle taken from the tummy or the thighs, usually during the same operation. It is a choice, not a requirement, and some women decide against it.
When the question comes up
Anterior, posterior and total exenteration can each remove some or all of the vagina, depending on where the cancer sits. If yours is part of the plan, the team should raise reconstruction before the operation. If nobody has, ask. It is much harder to add months later, once the pelvis has healed and scarred.
Why some women want it and some do not
For some, being able to have penetrative sex again, or simply feeling that the body is still whole, matters a great deal. For others, it adds operating time, a second wound and daily aftercare for something they do not expect to use. Both are reasonable. Neither is the right answer for everyone.
A reconstructed vagina can also help the pelvic wound heal, because the flap fills the empty space.The options
How is a new vagina made?
Each method uses tissue from a different place. The surgeon suggests one based on your body, earlier operations and where the stomas will go.
Tummy muscle and skin
A long muscle from the front of the tummy, with its skin, is rolled into a tube and brought down into the pelvis. Your report may call it a VRAM flap. It gives good bulk and fills the pelvis too.
May not suit
- Women needing stomas on both sides
- Earlier tummy scars across that muscle
Thigh flaps
Muscle and skin from both inner thighs, or thin skin flaps from the groin creases, are joined to form the new vagina. They leave the tummy wall alone but give less bulk.
A piece of bowel
Rarely, a short length of bowel is used. It makes its own moisture, but can produce too much mucus and adds a bowel join to an already large operation.
Choosing no reconstruction
The area between the legs is closed and the pelvis is filled another way if needed. Closeness and touch remain possible without penetration.
This is a real option, not a failure to choose.Not sure whether this applies to you?
Ask an oncologistHonest expectations
What will a reconstructed vagina feel like?
It will not be the same as before. A new vagina made from skin and muscle does not make natural moisture, so a lubricant is usually needed. Feeling inside it is different, and often less, because the nerves that supplied the original vagina are not part of the flap.
It can narrow if it is not kept open
Like any healing tissue, the new vagina tends to shrink and tighten, which your report may call stenosis. Regular use of a smooth plastic tube called a dilator, or regular sex once the team allows it, helps keep it open. This is a long-term habit, and it is the part many women find hardest.
Other things women notice
Skin flaps can carry hair, which may need attention. Some discharge is common. The donor site on the tummy or thighs has its own scar and soreness.
Who it may not suit
It may not be advised if you are frail and need the shortest possible operation, if earlier surgery has used up the tissue it would need, or if the cancer sits where a flap would be hard to place safely.
The recovery
What happens after the reconstruction?
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In hospital
Nurses check the colour and warmth of the flap often. There may be soft packing inside the new vagina for the first days, and you may be asked to avoid sitting straight up.
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Going home
You will be shown how to keep the area clean and what discharge is expected. Two wounds, the pelvis and the donor site, need watching.
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Starting dilators
When the team says the tissue has healed enough, a nurse shows you how to use a dilator privately at home. Ask for a female nurse if that makes it easier to talk.
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Talking about sex
At a later clinic visit, ask when sex is safe to try. Partners are welcome at that conversation if you want them there. Go slowly, use plenty of lubricant, and stop if it hurts. Some bleeding or soreness the first few times is common; heavy bleeding is not, and needs a call to the team.
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The longer term
Follow-up visits continue, for the cancer and for the new vagina. Tell the team if it is narrowing despite the dilator, if sex stays painful, or if you are finding the whole thing hard to cope with. Help is available for each of these, including counselling for you and your partner.
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Commonly believed
What do women and families often assume?
"At her age, there is no point asking about this."
Age alone does not decide it. Some older women want reconstruction and some younger women do not. It is her choice, and the surgeon should ask her directly, not only the family.
"Once it is rebuilt, everything will be as before."
It is a different vagina. It needs a lubricant, feels different and has to be kept open with a dilator or regular sex. Knowing this beforehand makes the choice fairer.
"It is too embarrassing to raise with the surgeon."
Surgeons who do these operations discuss it routinely. If you would rather speak to a woman, ask for a female doctor or nurse. Silence usually means the option is never offered.
"Without reconstruction, intimacy is over."
Closeness, touch and pleasure do not depend only on penetration. Many couples find their own way, and counselling can help.
On your report
What do the words in the plan mean?
- Neovagina
- The new vagina made during reconstruction.
- Flap
- Tissue moved from one part of the body to another while keeping its own blood supply.
- Donor site
- The place the flap was taken from, such as the tummy or thigh. It leaves its own scar.
- Dilator
- A smooth plastic tube used gently at home to keep the new vagina from narrowing.
- Stenosis
- Narrowing or tightening of the new vagina as it heals.
Did you know
This page cannot tell you whether reconstruction is right for you. The decision rests on your cancer, your body and what matters to you, and it is best made before the operation, with time to think and to ask questions.
Questions we are asked
Common questions about vaginal reconstruction
Is vaginal reconstruction done in the same operation?
Usually, yes. It is done after the cancer has been removed, often with a reconstructive surgeon joining for that part. Doing it later is possible in some women but harder, because the pelvis has healed and scarred. That is why it helps to discuss it during planning, not afterwards.
Will I be able to have sex again?
Many women with a reconstructed vagina can have penetrative sex once healed, though it feels different and needs a lubricant. Some find it uncomfortable or choose not to. Your team can tell you what to expect in your case, and when it is safe to try.
How long will I need to use a dilator?
Usually for a long time, often indefinitely if you are not having regular sex, because the new vagina tends to narrow. How often you use it changes over time. Your nurse will give you a plan and adjust it at follow-up visits.
Does reconstruction raise the risk of complications?
It adds time and a second wound, and the flap itself can lose part of its blood supply. On the other hand, the flap fills the empty pelvis, which can help the wound between the legs heal. Ask your surgeon how they weigh these for you.
Can I get pregnant after exenteration?
No. Exenteration that involves the vagina usually removes the womb as well, so pregnancy is not possible afterwards. If this is new or hard news, ask to speak to a counsellor. Talk to the team before the operation if fertility matters to you.
Will the new vagina be checked for cancer later?
Yes. Follow-up visits usually include looking at and feeling the area, and scans when the team feels they are needed. Tell the team about new bleeding, a lump, or pain that is getting worse, rather than waiting for the next appointment.
I do not want reconstruction. Is that all right?
Yes. Many women choose not to have it. Your surgeon should respect that and explain how the area will be closed instead. You can still ask about closeness, touch and support for your relationship. Changing your mind later is harder, so take the time you need before deciding.
Should my husband be part of this decision?
That is up to you. Many women want their partner involved, and some want to think it through alone first. The choice is yours, because it is your body. You can ask to speak to the surgeon privately before bringing family into the discussion.
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Sources
- Cancer Research UK — Pelvic exenteration for cervical cancer
- American Cancer Society — Surgery for Vaginal Cancer
- National Cancer Institute — Sexual Health Issues in Women with Cancer
- Macmillan Cancer Support — Surgery for cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Sexual Function After Pelvic ExenterationSex and closeness after the operation, with or without reconstructionFlap Reconstruction of the Pelvic FloorThe flaps that fill the pelvis and help the woundPelvic Exenteration: What the Operation RemovesWhich organs are taken in each typeThe Emotional Side of Cancer SurgeryBody image, grief and where to find support
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