About Your Vulvar Surgery

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

About your vulva

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.

Types of vulvar surgeries

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.

About your lymphatic system

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

Lymphatic mapping is a type of imaging scan. Before your scan, you’ll 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 67^th and East 68^th 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’ll 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’ll 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 6^th floor. If you’re having surgery at the JRSC, you can take the shuttle back to the JRSC.

Sentinel node biopsy

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’ll remove the sentinel node(s) so the Pathology Department can check 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.

Groin lymph node dissection

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.

Getting Ready for Your Surgery

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.

As you read through this section, write down questions to ask your healthcare provider.

Getting ready for surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you’re not sure.

• I take a blood thinner, such as:
  • Aspirin
  • Heparin
  • Warfarin (Jantoven® or Coumadin®)
  • Clopidogrel (Plavix®)
  • Enoxaparin (Lovenox®)
  • Dabigatran (Pradaxa®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
  There are others, so be sure your healthcare provider knows all the medications you’re taking.
• I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
• I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
• I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
• I’m allergic to certain medication(s) or materials, including latex.
• I’m not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke or use an electronic smoking device, such as a vape pen, e-cigarette, or Juul®.
• I use recreational drugs.

About drinking alcohol

The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

• If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medications to help keep them from happening.
• If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

Here are things you can do before your surgery to keep from having problems:

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
  • Get a headache.
  • Feel nauseous (like you’re going to throw up).
  • Feel more anxious (nervous or worried) than usual.
  • Cannot sleep.
  These are early signs of alcohol withdrawal and can be treated.
• Tell your healthcare provider if you cannot stop drinking.
• Ask your healthcare provider questions about drinking and surgery. As always, all your medical information will be kept private.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.

MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

About sleep apnea

Sleep apnea is a common breathing problem. It causes you to stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.

OSA can cause serious problems during and after a procedure. Please tell us if you have or think you might have sleep apnea. If you use a breathing device (such as a CPAP machine), bring it on the day of your procedure.

Within 30 days of your surgery

Presurgical Testing (PST)

You’ll have a PST appointment before your surgery. The date, time, and location will be printed on the appointment reminder from your surgeon’s office. You can eat and take your usual medications the day of your appointment.

It’s helpful to bring these things to your appointment:

• A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
• Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
• The names and telephone numbers of your healthcare providers.

During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests to plan your care. Examples are:

• An electrocardiogram (EKG) to check your heart rhythm.
• A chest X-ray.
• Blood tests.

Your NP may recommend you see other healthcare providers. They’ll also talk with you about which medications to take the morning of your surgery.

Identify your caregiver

Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.

For caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. MSK offers resources and support to help you manage them. For information, visit www.msk.org/caregivers or read A Guide for Caregivers.

Fill out a Health Care Proxy form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

• For information about health care proxies and other advance directives, read Advance Care Planning.
• For information about being a health care agent, read How to Be a Health Care Agent.
• If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.

Do breathing and coughing exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider may give you 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 healthcare provider.

Exercise

Exercising will help your body get into its best condition for your surgery and make your recovery faster and easier.

Try to do aerobic exercise every day. Aerobic exercise is any exercise that makes your heart beat faster, such as walking, swimming, or biking. If it’s cold outside, use stairs in your home or go to a mall or shopping center.

Follow a Healthy Diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®), if needed

If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, you’ll need to shower with a 4% CHG solution antiseptic skin cleanser before your surgery.

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser 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 a 4% CHG solution antiseptic skin cleanser.

7 days before your surgery

Follow your healthcare provider’s instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Herbal Remedies and Cancer Treatment.

2 days before your surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

Stop taking NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), 2 days before your surgery. NSAIDs can cause bleeding.

If your healthcare provider gives you other instructions, follow those instead.

For more information, read Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.

1 day before your surgery

Note the time of your surgery

A staff member from the Admitting Office will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.

Shower with a 4% CHG solution skin cleanser (such as Hibiclens), if needed

If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, shower using a 4% CHG solution antiseptic skin cleanser.

Do not use 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.

Sleep

Go to bed early and get a full night’s sleep.

Instructions for eating before your surgery

‌  
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.



 

The morning of your surgery

Instructions for drinking before your surgery

‌  You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.

Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.

Take your medications as instructed

A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.

Shower

If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it 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.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.

What to bring

• Your breathing device for sleep apnea (such as your CPAP device), if you have one.
• Your incentive spirometer, if you have one.
• Your Health Care Proxy form and other advance directives, if you 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 it to teach you how to care for yourself after surgery.

Once you’re in the hospital

You’ll 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.

Get dressed for surgery

When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight and the time you took them. Make sure to include prescription and over-the-counter medications, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

• Review your medical history with you.
• Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you’ll get.
• Answer your questions about your anesthesia.

Get ready for surgery

When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of your care team will help you onto a bed. They will put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV to make you fall asleep. You’ll also get fluids through your IV during and after your surgery.

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. A urinary (Foley) catheter will also be placed to drain urine (pee) 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.

Recovering After Your Surgery

This section will help you know what to expect after your surgery. You’ll learn how to safely recover from your surgery both in the hospital and at home.

As you read through this section, write down questions to ask your healthcare provider.

In the hospital

When you wake up after your surgery, you’ll 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’ll 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’ll have pain or discomfort at your incision sites. Your healthcare provider will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell your healthcare provider. 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’ll get a prescription for pain medication to take when you go home.

Your drains and incisions

You’ll 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’ll 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.

At home

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’ll 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’ll 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’ll 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.

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read About Your Recovery Tracker.

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’ll 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 healthcare provider 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 Your Cancer Treatment.

If you have questions about your diet, ask to see a clinical dietitian nutritionist.

About lymphedema

Lymphedema is swelling that usually happens in the arms, legs, or both. It’s usually caused by lymph nodes 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.

Emotional support

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’ll get stronger emotionally and physically. You’ll get more comfortable with your appearance. Your appetite and energy will improve. Before too long, you’ll be able to go back to doing most of your normal activities.

We have many resources to help you. Your healthcare providers 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 healthcare provider 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.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal account. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.

If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

For help, watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

When to Contact Your Healthcare Provider

Contact your healthcare provider if:

• 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 a.m. to 5:00 p.m., contact your doctor’s office.

After 5:00 p.m., during the weekend, and on holidays, call 212-639-2000 and ask to speak to the doctor on call for your doctor.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

As you read through this section, write down questions to ask your healthcare provider.

MSK support services

Visit the cancer types section of MSK’s website at www.msk.org/types for more information.

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
888-675-7722
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Caregivers Clinic
646-888-0200
www.msk.org/caregivers
At MSK, the Caregivers Clinic provides support specifically for caregivers who are having difficulty coping with the demands of being a caregiver. For more information, call Dr. Allison Applebaum’s office at 646-888-0200.

Counseling Center
646-888-0200
Many people find that counseling helps them. Our counseling center offers counseling for individuals, couples, families, and groups. We can also prescribe medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.

Female Sexual Medicine & Women’s Health Program
646-888-5076
Cancer and cancer treatments can affect your sexual health, fertility, or both. Our Female Sexual Medicine & Women’s Health Program can help with sexual health problems, such as premature menopause or fertility issues. We can help before, during, or after your treatment. Call for more information or to make an appointment.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. To schedule an appointment for these services, call 646-449-1010.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They will work with you to come up with a plan for creating a healthy lifestyle and managing side effects. To make an appointment, call 646-608-8550.

Male Sexual and Reproductive Medicine Program
646-888-6024
Cancer and cancer treatments can affect your sexual health, fertility, or both. Our Male Sexual and Reproductive Medicine Program can help with sexual health problems, such as erectile dysfunction (ED). We can help before, during, or after your treatment. Call for more information or to make an appointment.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org

Nutrition Services
www.mskcc.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. To make an appointment, ask a member of your care team for a referral or call the number above.

Patient and Caregiver Education
www.msk.org/pe
Visit our Patient and Caregiver Education website to search for educational resources, videos, and online programs.

Patient and Caregiver Peer Support Program
212-639-5007
It can be comforting to talk with someone who has been through a treatment like yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. Your conversations are private. They can be in person or over the phone.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call for more information.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. They also have information about financial resources, if you’re having trouble paying your bills.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
MSK has specialists who can help you quit smoking. For more information about our Tobacco Treatment Program, call 212-610-0507. You can also ask your nurse about the program.

Virtual Programs
www.msk.org/vp
Our Virtual Programs offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website for more information about Virtual Programs or to register.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Gilda’s Club
www.gildasclubnyc.org
212-647-9700
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.

Healthwell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
http://lgbtcancer.com/
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National Cancer Legal Services Network
www.nclsn.org
Free cancer legal advocacy program.

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medications.

NYRx
www.nyrxplan.com
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Partnership for Prescription Assistance
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medications.

Patient Access Network Foundation
www.panfoundation.org
866-316-7263
Provides assistance with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medications that they have trouble affording.

Educational resources

This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read through these resources, write down questions to ask your healthcare provider.

• About Your Recovery Tracker
• About Lymphedema of the Legs
• Advance Care Planning
• Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E
• Eating Well During Your Cancer Treatment
• Herbal Remedies and Cancer Treatment
• How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal
• 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