How much is removed in a vulvectomy, and what is left | CION Cancer Clinics

For most women, only the part of the vulva where the cancer sits is removed, with a rim of healthy skin around it, and the rest stays. Only a total radical vulvectomy removes the whole outer area, including the clitoris, and that is reserved for large or widespread cancers. The vagina, the bladder and the womb are not removed in any vulvectomy.

What decides the amount

Three things: how wide the cancer is, how deep it goes, and where on the vulva it sits. The surgeon needs a margin of normal-looking skin around the growth, because cancer cells can sit just beyond what the eye can see. A small cancer on the outer lip can be removed with very little change. A cancer sitting on the clitoris or close to the opening of the urethra needs the same margin, and that means more visible change.

After a wide local excision, the area looks much as before once healed, with a scar and one lip a little smaller. After a partial vulvectomy, one side looks flatter than the other. After a total radical vulvectomy the outer area is flat, with a scar running around the vaginal opening, and the folds are gone.

Scars in this area

The skin of the vulva heals with softer, less visible scars than skin elsewhere, and the scar fades over months. Where a flap of skin has been brought in from the thigh or buttock, that patch keeps the colour and hair of where it came from, so it looks and feels slightly different from the skin around it.

Sensation and function

Skin that has been cut is numb at first and regains some feeling over months, though rarely all of it. If the clitoris is kept, sexual sensation is usually preserved. If it is removed, that sensation changes, and it is honest to say so before the operation rather than after. Passing urine can spray sideways for a while if the urethra was close to the wound.

This page cannot tell you what your operation will remove. That depends on the size, depth and position of your cancer, and the surgeon may not know the exact edges until the operation itself. It also cannot tell you how you will feel about the change; women vary widely, and both distress and relief are normal.

Questions worth asking

Which parts will be removed, drawn on a diagram. Whether the clitoris will be kept. Whether the wound will be closed directly or with a flap. What the area is likely to look like at a month and at a year. Whether reconstruction is possible later, and who would do it. Whether you can talk to a counsellor before the operation.