This guide will help you get ready for your vulvar surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Read through this guide at least once before your surgery and use it as a reference in the days leading up to your surgery.
Bring this guide with you every time you come to MSK, including the day of your surgery. You and your healthcare team will refer to it throughout your care.
About Your Surgery
Vulva is another name for your external sex organs (genitals) (see Figure 1). Your vulva includes:
- The inner and outer lips of your labia.
- Your clitoris.
- The opening of your vagina.
- Your vaginal glands, which are in your perineum (the area between your vulva and anus).
Vulvar cancer is cancer in any of the organs that make up your vulva.
Vulvar surgery can be done to treat vulvar cancer or to remove tissue that may become vulvar cancer. A surgery to remove all or part of your vulva is called a vulvectomy.
There are several kinds of vulvectomies. The type of vulvectomy that you have will depend on how large your tumor is and whether it has spread to nearby lymph nodes. The types of vulvectomies are:
- Partial simple vulvectomy. With this type, a part of your vulva and the top layers of nearby tissue are removed.
- Partial radical vulvectomy. With this type, a part of your vulva and the deep layers of nearby tissue are removed (see Figure 2).
- Complete simple vulvectomy. With this type, your entire vulva is removed. Sometimes this is called a simple vulvectomy.
- Complete radical vulvectomy. With this type, your entire vulva, the deep tissue around it, and the surrounding lymph nodes are removed (see Figure 3).
You and your doctor will discuss the type of vulvectomy that you’re having.
Some women choose to have reconstruction as part of their surgery. If you’re having reconstruction, a plastic surgeon may help with that part of the surgery.
Most women can resume their normal sexual activities after their incisions (surgical cuts) have healed. But, this depends on the extent of your surgery and the areas of your vulva that were removed. Talk with your doctor about your concerns about sexual activities after your surgery.
Your lymphatic system is part of your immune system (see Figure 4). It’s made up of:
- Lymph nodes. These are small, bean-shaped structures located along your lymphatic vessels. Your lymph nodes filter out bacteria, viruses, cancer cells, and other waste products.
- Lymphatic vessels. These are tiny tubes (like blood vessels) that carry lymphatic fluid to and from your lymph nodes.
- Lymphatic fluid. This is the clear fluid that travels through your lymphatic system. It carries cells that help fight infections and other diseases.
Sometimes, cancer cells can enter lymphatic vessels and travel to nearby lymph nodes and other parts of your body. A sentinel lymph node (also called a sentinel node) is the first lymph node or group of nodes where cancer cells are most likely to spread.
Your doctor might want to do a sentinel lymph node biopsy during your surgery to check if cancer has spread. If they do, you will have lymphatic mapping on the morning of your surgery.
Lymphatic mapping is a type of imaging scan. Before your scan, you will get an injection (shot) of a radioactive liquid. The pictures taken during your scan will show the flow of the radioactive liquid and which lymph nodes absorb it. Your surgeon will use this as a map to see the location of the sentinel node(s).
Where to go
Your lymphatic mapping procedure will be done in the Molecular Imaging and Therapy Service (MITS) at Memorial Hospital (MSK’s main hospital). The MITS is sometimes called Nuclear Medicine. The best entrance to use is the one at 1250 First Avenue, between East 67th and East 68th Streets.
The staff member at the front desk will direct you to the MITS. Check in at the Radiology Department reception desk next to the elevators.
If your surgery is at the Josie Robertson Surgery Center (JRSC), it’s best to park there and travel to Memorial Hospital for your lymphatic mapping. There’s a shuttle that will take you to Memorial Hospital and back to the JRSC after your mapping.
What to Expect
First, you will get an injection of a small amount of a radioactive liquid near the site of the cancer. The injection might sting or burn. The radioactive liquid will travel to the sentinel node(s) so they can be seen later during your scan. After you get the injection, you can either stay in the hospital or leave for a while. It’s important to come back on time for your scan, so be sure to note the time you’re told to return.
When it’s time for your scan, a staff member will take you to the scanning room. You will lie on a narrow table while they take a series of pictures. Each picture takes 5 minutes. It’s important to lie very still during each picture. If you feel uncomfortable staying in any position for 5 minutes, ask the staff member to count down the time for you. Your scan will take 10 to 15 minutes total.
After Your Lymphatic Mapping
If you’re having surgery at Memorial Hospital, a staff member will bring you to the Presurgical Center on the 6th floor. If you’re having surgery at the JRSC, you can take the shuttle back to the JRSC.
Your sentinel lymph node biopsy will be done during your surgery. Your surgeon will inject a small amount of blue dye near the site of the cancer. The dye will travel in your lymphatic fluid to the sentinel node(s), staining them blue.
Your surgeon will also use a small device that measures radioactivity from the liquid injected during your lymphatic mapping. Once they locate the sentinel node(s), your surgeon will make a small incision. The sentinel nodes will be blue from the blue dye, allowing your surgeon to see them. They will remove the sentinel node(s) and they will be examined by the Pathology department to see if they contain cancer cells.
Because blue dye was used during your procedure, your skin, urine (pee), and bowel movements (poop) may be a bluish-green color for 1 to 2 days after your surgery.
A groin lymph node dissection is removal of most or all of the lymph nodes in your groin. The number of nodes varies from person to person. It can be done on 1 or both sides of your perineum.
If cancer cells are found in your sentinel lymph node(s), you may have a groin lymph node dissection as part of your vulvar surgery. Sometimes, you and your doctor might decide to do a groin lymph node dissection without doing a sentinel lymph node biopsy. This can happen if you had an imaging scan or other test that showed cancer in your lymph nodes. If this applies with you, your doctor with talk with you to decide what’s best for you.Back to top
Before Your Surgery
Do Breathing and Coughing Exercises
Practice taking deep breaths and coughing before your surgery. You may be given an incentive spirometer to help expand your lungs. For more information, read How to Use Your Incentive Spirometer. If you have any questions, ask your nurse or respiratory therapist.
Buy Hibiclens® Skin Cleanser, if Needed
If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, you will need to shower using Hibiclens before your surgery.
Hibiclens is a skin cleanser that kills germs for 24 hours after you use it (see figure). Showering with Hibiclens before your surgery will help lower your risk of infection after surgery. You can buy Hibiclens at your local pharmacy without a prescription.
If you’re not having a sentinel lymph node biopsy or a groin lymph node dissection, you don’t need to buy Hibiclens.
Note the Time of Your Surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they will call you on the Friday before.
The staff member will tell you what time to arrive at the hospital for your surgery. They will also remind you where to go.
If you don’t get a call by 7:00 pm, please call 212-639-5014.
Shower With Hibiclens, if Needed
If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, shower using Hibiclens on the night before your surgery.
- Use your normal shampoo to wash your hair. Rinse your head well.
- Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
- Open the Hibiclens bottle. Pour some solution into your hand or a washcloth.
- Move away from the shower stream to avoid rinsing off the Hibiclens too soon.
- Rub the Hibiclens gently over your body from your neck to your feet. Don’t put the Hibiclens on your face or genital area.
- Move back into the shower stream to rinse off the Hibiclens. Use warm water.
- Dry yourself off with a clean towel after your shower.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
If you’re not having a sentinel lymph node biopsy or a groin lymph node dissection, you can shower as usual.
If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, shower using Hibiclens just before you leave. Use the Hibiclens the same way you did the night before. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
If you’re not having a sentinel lymph node biopsy or a groin lymph node dissection, you can shower as usual. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to Remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
- Before you’re taken into the operating room, you will need to remove your hearing aids, dentures, prosthetic device(s), wig, and religious articles.
What to Bring
- Your breathing machine for sleep apnea (such as your CPAP machine), if you have one.
- Your portable music player, if you choose. However, someone will need to hold it for you when you go into surgery.
- Your incentive spirometer, if you have one.
- Your Health Care Proxy form and other advance directives, if you have completed them.
- Your cell phone and charger.
- Only the money you may want for small purchases (such as a newspaper).
- A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
- This guide. Your healthcare team will use this guide to teach you how to care for yourself after your surgery.
Once You’re in the Hospital
You will be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.
During Your Surgery
After you’re fully asleep, a breathing tube will be placed through your mouth and into your windpipe to help you breathe. You will also have a urinary (Foley®) catheter placed to drain urine from your bladder.
During your surgery, your surgeon will make 1 or more incisions (surgical cuts) in your vulvar area. Your surgeon will then remove the tumor and all or part of your vulva. They may also remove some of the lymph nodes in your groin.
If you’re having reconstruction as part of your surgery, your surgeon may work with a plastic surgeon for that part of your surgery.
At the end of your surgery, your surgeon will close your incision(s) with sutures (stitches).Your breathing tube is usually taken out while you’re still in the operating room.Back to top
After Your Surgery
When you wake up after your surgery, you will be in a recovery room or the Post-Anesthesia Care Unit (PACU). Some people may stay in the PACU overnight for observation.
A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You will also have compression boots on your lower legs.
Because of the area where your surgery was, sitting may be uncomfortable or may harm your incisions. Don’t sit until your nurse tells you that you can. Once you know it’s okay to sit, be sure to use a soft pillow or donut (soft inflatable plastic ring) to protect your incision.
Managing Your Pain
You will have pain or discomfort at your incision sites. Your doctor and nurse will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your doctor or nurse. It’s important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk. You will get a prescription for pain medication to take when you go home.
Your Drains and Incisions
You will have tubes, drains, and bandages on and around your vulvar area. They may include:
- A catheter or drainage tube to drain urine from your bladder.
- A Jackson-Pratt drain, if any of your lymph nodes were removed. This will help drain the fluid from your groin area and control lymphedema (swelling).
You may also have:
- An IV line to give you fluids.
- A pain pump called a patient-controlled analgesia (PCA) device. If you have a PCA device, read the resource Patient-Controlled Analgesia (PCA) for more information.
- Compression boots on your calves to help blood circulate. These will stay on whenever you’re in bed until you’re discharged.
Your vulvar incision(s) will be closed with sutures that may loosen over time. A small amount of reddish drainage is normal. The incision(s) in your groin will be closed with staples or sutures. These will remain in place until you see your surgeon about 2 to 4 weeks after surgery.
You may go home with the drains still in place as well. If so, your nurse will teach you how to care for them before you leave the hospital.
Be sure to look at your incisions with your nurse before you leave the hospital so you know what they look like and can notice any changes. Your nurse will also teach you how to care for your incisions at home. They will give you a peri-bottle (a small plastic bottle with a squirt tip) for cleaning your vulvar incisions (around your vulva and perineum) and will show you how to use it.
Moving to Your Hospital Room
Depending on the type of surgery you had, you may stay in the PACU for a few hours or overnight. After your stay in the PACU, you will be taken to your hospital room.
Read the resource What You Can Do to Avoid Falling to learn about what you can do to stay safe and keep from falling at home and during your appointments at MSK.
You will need time to heal and recover. Some women need longer to heal than others. Ask your healthcare provider what you should expect. They can tell you more based on the surgery you had and how much tissue was removed.
For the first 3 to 4 weeks, you will only be able sit with the help of a soft pillow or donut. You can purchase a donut from a local surgical supply store, or you can order one online.
You will be able to lie down or stand. If you had major surgery or reconstructive surgery, you may not be able to sit for up to 8 weeks. Your nurse will work with you to design a care plan that focuses on finding positions that are most comfortable for you.
Caring for Your Incisions
Wound healing after vulvar surgery has its own unique challenges related to where the incisions are located. The moisture and rubbing that happens with daily activities is a natural challenge to vulvar wound healing. Urinating may be painful.
To keep your incisions clean:
- Using your peri-bottle, wash your vulvar and anal areas with warm water after each time you urinate or have a bowel movement.
- Use a sitz bath or hand spray shower at least 2 times every day.
- Shower every day, using soap and water.
To dry your incisions, pat them dry with a clean towel or use the “cool” setting on a hair dryer. Do not rub your incisions.
Here are some tips to make you more comfortable while your incision(s) are healing:
- Apply ice packs to the affected area as directed.
- Wear loose fitting clothing: either underwear that is a size larger or men’s boxer shorts.
- Keep the area open to air at night.
You will see your surgeon about 2 to 4 weeks after surgery to check your incisions and remove any remaining staples, sutures, or drains.
Eating and Drinking
You can eat all the foods you did before your surgery, unless your doctor gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.
It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.
For more tips on eating and drinking after your surgery, read the resource Eating Well During and After Your Cancer Treatment.
If you have questions about your diet, ask to see a clinical dietitian nutritionist.
Lymphedema is swelling that usually happens in the arms, legs, or both. It’s usually caused by lymph node4s being removed. If you had a groin lymph node dissection, you may have lymphedema in the leg on the side the nodes were removed.
There are many things you can do to help prevent and manage lymphedema. For more information, read the resource Reducing Your Risk of Lymphedema of the Legs or watch the videos About Lymphedema of the Legs and Treatment for Lymphedema of the Legs.
This surgery will change your body. It will probably take time for you to adjust to these changes. You may feel frightened, angry, or worried. You may have questions or fears about how this surgery will impact your sexuality and sexual activities These feelings are normal, and most people have them.
Everyone adjusts in their own way. For some people, it takes a few months to adjust to a changed body image. For other people, it may take longer. As time goes on, you will get stronger emotionally and physically. You will get more comfortable with your appearance. Your appetite and energy will improve. Before too long, you will be able to go back to doing most of your normal activities.
We have many resources to help you. Your doctors and nurses will answer your questions. We also have social workers, psychologists, and psychiatrists who have helped many women through this change. You can have one-on-one counseling, or you can join one of our online or in-person support groups. We also have clergy available for spiritual support.
You may be able to meet with another person who has had this surgery. They can talk with you and answer your questions. Talk with your nurse if you’re interested in doing this.
Every new situation requires time to adjust. We’re here to help you through this time.
Your Sexuality after Surgery
Talk with your doctor about when it’s safe for you to resume sexual activities. This is usually after your incision is fully healed.
Most women who have a partial or a simple vulvectomy can resume their normal sexual activities after their incisions have healed. If you had a complete radical vulvectomy, had radiation therapy before your surgery, or had extensive reconstruction around your vaginal opening, you may have vaginal tightness. This can make intercourse difficult. Using lubrication can help.
To address issues with sexual health and intimacy, ask to see someone from our Female Sexual Medicine & Women’s Health Program. For more information or to make an appointment, call 646-888-5076.
- You have a fever of 100.5 °F (38 °C) or higher.
- You have chills.
- The area around your incision is starting to swell.
- Swelling around your incision is getting worse.
- You have increased discomfort in the area of your incisions.
- You have drainage or a foul odor (bad smell) from your incisions.
- You have bleeding from your incisions.
- You have trouble urinating (peeing).
- You have any problems you didn’t expect.
- You have any questions or concerns.
Monday through Friday from 9:00 am to 5:00 pm, contact your doctor’s office.
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the doctor on call for your doctor.Back to top
Support ServicesBack to top
- About Lymphedema of the Legs
- Advance Care Planning
- Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Eating Well During and After Your Cancer Treatment
- Herbal Remedies and Cancer Treatment
- How to Enroll in the Patient Portal: MyMSK
- How to Use Your Incentive Spirometer
- Information for Family and Friends for the Day of Surgery
- Patient-Controlled Analgesia (PCA)
- Reducing Your Risk of Lymphedema of the Legs
- Treatment for Lymphedema of the Legs
- What You Can Do to Avoid Falling