A vulvectomy is surgery to remove part or all of the vulva, the external tissue surrounding the opening of the vagina. It is primarily performed to treat vulvar cancer or precancerous changes in the skin of the vulva. The extent of the surgery depends on how much tissue is affected, ranging from a small surface-level removal to a much larger operation involving deeper tissue and lymph nodes.
Why a Vulvectomy Is Performed
The most common reason for a vulvectomy is vulvar cancer. Surgery is the standard treatment across nearly every stage of the disease, though the scope of the operation increases as the cancer advances. For early-stage tumors (confined to the vulva and smaller than 2 cm), a more limited procedure is typical. Larger tumors or those that have spread to nearby structures require more extensive removal, sometimes combined with lymph node surgery in the groin.
Vulvectomy is also used for precancerous conditions called vulvar intraepithelial neoplasia, or VIN. In these cases, abnormal cells are present in the surface layer of vulvar skin but haven’t invaded deeper tissue. A superficial “skinning” procedure can remove the affected skin before it has the chance to become cancerous. Less commonly, vulvectomy may be recommended for recurrent cancer that returns after initial treatment.
Types of Vulvectomy
There are several types, and the names describe how much tissue is removed and how deep the surgery goes.
- Skinning vulvectomy: Only the top layer of affected skin is removed, leaving the tissue underneath intact. This is typically used for precancerous changes and is sometimes followed by a skin graft.
- Simple (or partial) vulvectomy: Removes the affected area of the vulva along with a margin of healthy tissue around it. This is common for smaller, early-stage cancers.
- Radical partial vulvectomy: Removes a portion of the vulva along with deeper tissue beneath it. It targets a specific area rather than the entire vulva but goes deeper than a simple vulvectomy.
- Radical vulvectomy: Removes the entire vulva and the deeper tissue underneath. This is reserved for larger or more advanced cancers and is often combined with removal of lymph nodes in the groin.
For advanced or recurrent cancers, radical vulvectomy may be paired with even more extensive surgery to remove affected organs in the pelvic area.
Lymph Node Assessment During Surgery
When vulvar cancer has the potential to spread, surgeons often need to check whether cancer cells have reached the lymph nodes in the groin. For smaller tumors (under 4 cm) with no signs of spread on imaging, a sentinel lymph node biopsy is an option. This involves identifying and removing just the first few nodes that drain the tumor site, which limits the side effects of a full lymph node removal.
If the tumor is larger, or if sentinel nodes can’t be reliably identified (which can happen when a previous surgery has altered lymph drainage patterns in the area), a full removal of the groin lymph nodes is performed instead. This more extensive approach is significantly more likely to cause complications afterward, particularly swelling in the legs from disrupted lymph flow.
What Recovery Looks Like
Recovery time varies significantly depending on the type of vulvectomy. After a simple vulvectomy or a radical partial vulvectomy with a small incision, you can typically go home the same day and resume light activities like walking right away. If reconstructive surgery is needed (for instance, a skin graft after a larger removal), a hospital stay of a few days is more likely.
Sexual activity is off-limits for several weeks after any type of vulvectomy to allow the incision to heal. Full recovery from more extensive procedures takes longer, and the timeline depends on whether complications develop.
Wound Care at Home
Keeping the surgical site clean and dry is the central task of home recovery. The area should be rinsed with warm water after every trip to the bathroom, using a handheld shower head or a squirt bottle. Soap should not be applied directly to the incision, though fragrance-free soap can be used elsewhere during a daily shower.
Drying the area thoroughly after rinsing matters just as much as keeping it clean. Patting gently with a clean towel works, as does using a fan or a hair dryer set to the cool setting. Rubbing the incision should be avoided entirely. Each day, you should visually check the incision for redness, increased swelling, drainage, or any opening in the wound. Sitz baths (soaking in a few inches of warm water) can help with pain but should be limited to 5 to 10 minutes, with careful drying afterward.
Common Complications
The three most frequent complications after vulvar cancer surgery are wound separation (dehiscence), fluid collection near the surgical site (lymphocele), and chronic swelling in the legs (lymphedema). In a study of 121 patients, roughly 18% experienced wound separation, 18% developed a fluid collection, and 20% developed lymphedema. Broader data across multiple studies show these rates can range considerably: 17 to 39% for wound separation, 7 to 40% for fluid collections, and 14 to 49% for lymphedema.
The risk of these complications is closely tied to how much lymph node surgery is performed. Full groin lymph node removal carries significantly higher rates of all three complications compared to sentinel node biopsy alone. In patients who had full lymph node removal, about 27% experienced wound separation, 23% developed a fluid collection, and 14% developed lymphedema. Developing a fluid collection or wound separation early on also appears to increase the risk of long-term lymphedema.
Lymphedema, persistent swelling in one or both legs caused by damaged lymph drainage, is the complication most likely to become a lasting issue. It can develop weeks or even months after surgery and may require ongoing management with compression garments, specialized massage, or physical therapy.
Effects on Sexual Function and Body Image
Because the vulva plays a central role in sexual sensation, any vulvectomy can affect how sex feels afterward. The degree of change depends on how much tissue was removed. A skinning vulvectomy or small partial removal may cause relatively modest changes, while a radical vulvectomy involves the loss of structures like the clitoris and labia, which significantly alters sensation and appearance.
Reconstructive surgery can restore some of the external anatomy, and many people do resume sexual activity after recovery. The adjustment is both physical and emotional. Changes in how the area looks and feels can affect self-image and intimacy in ways that take time to process, and support from a therapist or counselor who specializes in sexual health can be genuinely helpful during that transition.