The vulva constitutes the set of the external genitalia of the woman, and includes / understands: 

• the labia majora and labia minora;
• the clitoris;
• the urinary meatus which constitutes the place of exit of urine;
• and finally the entrance to the vagina also called the vestibule of the vagina. 

Vulvectomy is a surgical operation that involves removing the vulva either partially or entirely. There are, therefore, several types of vulvectomy. 

A simple vulvectomy involves removing the entire vulva, but leaving most of the underlying tissue in place. Doctors frequently do this type of surgery to remove VIN (vulvar intraepithelial neoplasia) that is present in several places on the vulva.

These vulvar intraepithelial neoplasms remain a benign disease. However, their frequency is increasing, especially in young patients. This is linked to the development of genital infections due to HPV (Human papilloma virus). You should also be aware that some forms of VIN can degenerate into invasive cancer. There are also two types of radical vulvectomy.

Radical partial vulvectomy involves removing part of the vulva as well as tissue located deeper under the tumor. Sometimes the clitoris is also removed. It is in fact the most common type of vulvectomy performed in the context of the treatment of cancer of the vulva.

Finally, the total radical vulvectomy is the removal of the entire vulva, the labia majora and the labia minora, of the tissues located deeper under the vulva as well as of the clitoris.

Vulvectomy is performed because of the presence of precancerous and cancerous lesions in the vulva. This surgery has two main indications:

• Either it allows to completely remove the tumor, as well as a margin of normal tissue around;
• Either it aims to alleviate the pain or relieve the symptoms, and in this case it is a palliative surgery.

Before the operation, some medicines will need to be stopped, such as certain anti-inflammatory drugs and anticoagulants (which make the blood more fluid). It is also strongly recommended to stop smoking at least 4 to 8 weeks before the operation. In all cases, care must be taken to follow the doctor’s instructions. 

The surgery takes place either:

• in regional anesthesia (which then concerns the entire lower body);
• or in general anesthesia (the patient is completely asleep). 

The surgeon removes the vulva or part of the vulva before closing the incision or incisions with a suture or staples. This operation lasts on average 1 to 3 hours. In very rare cases, it is necessary to carry out additional skin grafts, in order to be able to close the wound. 

Usually, pain relievers given during the postoperative period are effective in controlling the pain. The length of stay in hospital is usually 1 to 5 days, it can vary depending on the type of intervention performed. 

After surgery, you should expect the presence of various devices:

• Thus, a solution allows the patient to hydrate and will be withdrawn as soon as she can drink sufficiently and resume eating normally;
• A dressing can also be applied to the wound, and removed after a few days;
• Staples, if any, are removed within 7-10 days of surgery;
• Inguinal drains, which are tubes located in the groin, can be installed when the surgeon has removed one or more inguinal lymph nodes: these tubes allow the evacuation of the liquids accumulated in the operated area and will be removed within a few days. following surgery; 
• Finally, a bladder catheter is installed in your bladder: it allows the elimination of urine and will be removed after 24 or 48 hours following the vulvectomy. In some cases, this bladder catheter can stay in place longer.

Bleeding following the operation is rare and not very abundant. Nurses clean the operated area, the vulva, 3 times a day during the hospital stay, which helps the wound heal. The return to feeding is done immediately in most cases, and it is the doctor or nurse who will advise the patient when to resume eating and drinking. It is also necessary to start to mobilize again, and, in addition, to perform breathing exercises. It is possible that when you return home, the anticoagulant injections started in the hospital will be continued: these make it possible to prevent the formation of blood clots.

Vulvar surgery is still the most effective treatment for this cancer. It has very good results, in particular against VIN, vulvar intraepithelial neoplasia which, as has already been mentioned, often remains not very serious but whose frequency turns out to be increasing. However, vulvectomy always leaves sequelae, whether aesthetic, functional and obviously psychological.

In addition, when radical total vulvectomy has been required, it can severely deform the vulva, but also cause major loss of sexual function.

The prolonged follow-up of patients who have undergone partial or total removal of the vulva is essential, since there are relatively high risks of recurrence, for vulvar intraepithelial neoplasia in particular. HPV vaccination is likely to have the positive result of reducing the incidence of this type of vulvar cancer, at least for the forms that are caused by the virus.

Side effects from treatment for vulvar cancer may occur. Each woman will perceive them differently. These side effects can occur during surgery, sometimes right after, or even a few days or weeks later. Sometimes there are also late effects, which occur several months or even years after surgery.

Here are the different side effects that can occur after vulvectomy: 

• pain;
• poor wound healing;
• damage to the nerves resulting in numbness or tingling;
• changes in the function of the vulva as well as its appearance (especially if the surgery is extensive, and manifested for example by a jet of urine that goes to one side). 

In addition, infections can occur, or lymphedema, that is to say swelling due to the accumulation of lymphatic fluid in the tissues. Finally, vulvectomy can have side effects on sexuality, it has already been mentioned, and particularly the modification of desire and response.

Most side effects go away on their own or when treated, although some can sometimes last for a long time or even be permanent. In all cases, it is essential to warn the healthcare team which took charge of the operation very quickly as soon as the operated patient experiences one of these side effects. The sooner a problem is mentioned, the faster the healthcare team can react to indicate how to relieve it.