Surgical procedures are usually reserved for small stage I lesions, for radiation therapy failures, for stage I clear cell adenocarcinomas, and for nonepithelial tumors (sarcomas).

The extent of the surgery depends on the size and stage of the cancer. It can range from laser surgery or local excision needed to remove a precancer (VAIN) to radical vaginectomy (removal of the vagina and adjacent tissues), sometimes together with radical hysterectomy (removal of the uterus with adjacent connective tissue) and lymphadenectomy (removal of lymph nodes from the groin area or from inside the pelvis near the vagina).

If all or most of the vagina must be removed, it is possible to reconstruct a vagina with tissue from another part of the body, which will allow a woman to have intercourse. A new vagina can be surgically created out of skin, intestinal tissue, or myocutaneous (muscle and skin) grafts.

A reconstructed vagina produces little or no natural lubricant when a woman becomes sexually excited. A woman should prepare for intercourse by using a lubricating gel inside the vagina. During intercourse with a rebuilt vagina, a woman may at first feel that her thigh is being stroked. This is because the walls of the vagina are still attached to their original nerve supply. Over time, these feelings become less distracting and may even become sexually stimulating. (For more information about the impact of vaginal reconstruction, see the American Cancer Society document, Sexuality and Women: For the Woman Who Has Cancer and Her Partner.)

Although vaginal cancers are usually treated by radiation therapy, if a woman has already had radiation for cervical cancer, additional radiation might cause severe complications. In this case, it may be necessary to perform pelvic exenteration. This is a very extensive operation that combines a radical hysterectomy with removal of the vagina and possibly the bladder, rectum, and part of the colon. The extent of the surgery depends on how far the cancer has spread.

If the bladder is removed, a new way to store and eliminate urine is needed. Usually a short segment of intestine is used to function as a new bladder. This may be connected to the abdominal wall so that urine is drained periodically when the woman places a catheter into a urostomy (small opening). Or urine may drain continuously into a small plastic bag attached to the front of the abdomen.

If the rectum and part of the colon are removed, a new way to eliminate solid waste is needed. This is done by attaching the remaining intestine to the abdominal wall so that fecal material can pass through a colostomy (a small opening) into a small plastic bag worn on the front of the abdomen. It may be possible to remove the involved colon and reconnect the free ends of it, so no bags or external appliances are needed. Last Revised: 07/21/2006