Sexuality for the Woman With Cancer

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Surgery for cancer of the vulva (vulvectomy)

Cancer of the vulva is sometimes treated by removing all or part of the vulva. This operation is called a vulvectomy. A partial vulvectomy removes only the affected area and an edge (or margin) of tissue around the cancer, which is called “getting a clear margin.” The modified radical vulvectomy removes the affected area and an edge of tissue for a clear margin. In this case, this usually includes removal of some of the lymph nodes in the groin area. If there’s cancer in or very near the clitoris, it may need to be removed to be sure the cancer is taken out.

The most extensive surgery is called a radical vulvectomy, which is rarely ever done. Here the surgeon removes the whole vulva. This includes the inner and outer lips and the clitoris, and often the lymph nodes that drain lymph fluid from the vulva. The vagina, uterus, and ovaries remain intact. Doctors often try to spare as much of the vulva as they safely can, as it’s not often necessary to remove the entire vulva to get a clear margin around the cancer.

After part or all of the vulva has been removed, women often feel discomfort if they wear tight slacks or jeans since the “padding” around the urethral opening and vaginal entrance is gone. The area around the vagina also looks very different.

Women often fear their partners may be turned off by the scarring and loss of outer genitals, especially if they enjoy oral stimulation as part of sex. Some women may be able to have reconstructive surgery to rebuild the outer and inner lips of the genitals. It may help with the way the vulva looks, but the feeling (sensation) will be different.

When touching the area around the vagina, and especially the urethra, a light caress and the use of a lubricant can help prevent painful irritation. If scar tissue narrows the entrance to the vagina, penetration may be painful. Vaginal dilators can sometimes help stretch the opening. When scarring is severe, the surgeon may use skin grafts to widen the entrance. Vaginal moisturizers on the external genital area can also be very helpful and promote comfort. (See “Vaginal moisturizers.”)

When the lymph nodes in the groin have been removed, women may have swelling of their genital areas or legs. Though swelling just after surgery may go away, it can become a long-term problem. This condition, called lymphedema, can cause pain, a feeling of heaviness, and fatigue. It also can be a problem during sex. Couples should discuss these issues to decide what solutions work best for them. (If you want to read more about lymphedema in the groin or legs, you can get our document called Understanding Lymphedema – For Cancers Other Than Breast Cancer. See the “To learn more” section.)

Orgasm after vulvectomy

Women who have had a vulvectomy may have problems reaching orgasm, depending on how much of the vulva has been removed. The outer genitals, especially the clitoris, are important in a woman’s sexual pleasure. If surgery has removed the clitoris and lower vagina, then orgasms may not be possible. Some women find that stroking the front inside (bladder side) part of the vagina, about 1 to 4 inches inside the opening, can feel pleasurable.

Also, after vulvectomy, women may notice numbness in their genital area. Feeling may return slowly over the next few months.

Last Medical Review: 08/29/2013
Last Revised: 08/29/2013