Abdominoperineal resection

Abdominoperineal (AP) resection for colon cancer is surgery that removes the lower colon and rectum. It also creates a colostomy so that stool can pass out of the body. There are many different ways to do AP resections. In a younger woman, just the colon and rectum may be removed. But sometimes the uterus, ovaries, and even the rear wall of the vagina must be removed, too. The remaining vaginal tube must then be repaired with skin grafts or with a flap made of skin and muscle.

AP resection does not damage the nerves that control the feeling in a woman’s genitals and allow orgasm. Some women may notice vaginal dryness, especially if their ovaries were removed. If so, a water-based gel lubricant can help make vaginal penetration more comfortable. Regular use of a vaginal moisturizer can also help improve vaginal dryness and make the tissues more flexible. (See the section called “Vaginal dryness” for more on these products.)

Intercourse in certain positions may be uncomfortable or even painful. Without a rectum, the vagina becomes scarred down to the sacrum (tailbone). A couple may need to try different positions to find one that works for them. If a skin graft or flap was used to repair the vagina, the section called “Vaginal reconstruction after total pelvic exenteration” in the “Total pelvic exenteration” section may be helpful.

For suggestions on how to manage an ostomy during sex, see “Urostomy, colostomy, or ileostomy” under the section called “Special aspects of some cancer treatments.” (If you would like to read more about colostomies, see our document called Colostomy: A Guide. See the “To learn more” section for more information.)