Vulvectomy: Purpose, Types, Procedure, and More

A vulvectomy is a surgery to remove part or all of the vulva, the external genital area that may include the labia majora, labia minora, clitoris, vaginal opening, urethral opening, and nearby skin. It sounds intimidating because, frankly, it is not the kind of word anyone hopes to see on a medical chart. But for many people with vulvar cancer, precancerous vulvar changes, or serious vulvar disease, this operation can be a carefully planned, tissue-sparing, life-protecting treatment.

The key thing to understand is that “vulvectomy” is not one single cookie-cutter procedure. Surgeons do not simply choose the biggest option and call it a day. Modern vulvar surgery is usually tailored to the exact location, size, depth, and diagnosis of the abnormal tissue. The goal is to remove the problem while preserving as much healthy tissue, function, comfort, and appearance as safely possible.

This guide explains the purpose of vulvectomy, the main types, what happens before and during surgery, recovery expectations, possible risks, and the real-life experiences many patients wish they had been prepared for.

What Is a Vulvectomy?

A vulvectomy is an operation that removes diseased tissue from the vulva. Depending on the diagnosis, the surgeon may remove a small section of vulvar skin, deeper tissue beneath a tumor, nearby lymph nodes in the groin, or, rarely, most or all of the vulva.

Although vulvectomy is most often discussed in the context of vulvar cancer, it may also be used for precancerous conditions or severe noncancerous vulvar disorders that do not respond to other treatments. The exact operation depends on the medical reason for surgery and the balance between removing enough tissue and preserving normal function.

Why Is a Vulvectomy Performed?

The main purpose of a vulvectomy is to remove abnormal, precancerous, or cancerous tissue from the vulvar area. In many cases, surgery is part of a broader treatment plan created by a gynecologic oncologist, a doctor who specializes in cancers of the female reproductive system.

Vulvar cancer

Vulvar cancer is the most common reason for a vulvectomy. The most common type is squamous cell carcinoma, but vulvar cancer may also include melanoma, adenocarcinoma, basal cell carcinoma, sarcoma, or Paget disease of the vulva. Symptoms can include persistent itching, burning, bleeding, skin color changes, thickened patches, sores, ulcers, wart-like bumps, or a lump that does not go away.

A biopsy is usually required to confirm cancer. Once the diagnosis is clear, the care team determines whether surgery alone is enough or whether radiation therapy, chemotherapy, or both may also be needed.

Vulvar intraepithelial neoplasia

Vulvar intraepithelial neoplasia, often shortened to VIN, is a precancerous change in the cells on the surface of the vulva. Not everyone with VIN develops cancer, but some forms can progress if left untreated. Treatment may involve topical medicine, laser treatment, local excision, or a limited vulvectomy, depending on the size, location, and severity of the abnormal tissue.

Severe vulvar skin disease

Some chronic vulvar skin conditions can cause scarring, pain, itching, tearing, and tissue changes. Lichen sclerosus, for example, is usually treated with medication, not surgery. However, surgery may be considered in select cases when there is suspicious tissue, severe scarring, or disease that has not responded to conservative care.

Benign but troublesome growths

Occasionally, vulvectomy-like procedures may be used to remove benign growths, cysts, extensive skin changes, or lesions that create discomfort, hygiene problems, or uncertainty about cancer risk. In these situations, the surgery is often more limited.

Types of Vulvectomy

The word “vulvectomy” covers several operations. Think of it like ordering coffee: “coffee” could mean espresso, cold brew, or something with whipped cream tall enough to need its own zip code. The details matter.

Partial simple vulvectomy

A partial simple vulvectomy removes part of the vulva and the upper layers of nearby tissue. It may be used for small tumors, precancerous lesions, or abnormal areas that do not involve deep tissue. The surgeon removes the affected area with a margin of normal-looking tissue around it.

Complete simple vulvectomy

A complete simple vulvectomy removes the entire vulva but does not remove deeper tissues or lymph nodes. This operation is less common than partial procedures and may be used for widespread precancerous disease or selected surface-level conditions.

Skinning vulvectomy

A skinning vulvectomy removes the top layer of vulvar skin while leaving deeper structures in place. It may be considered when abnormal cells are limited to the surface. Sometimes skin grafting or reconstruction is needed afterward to help cover the area.

Partial radical vulvectomy

A partial radical vulvectomy removes part of the vulva along with deeper tissue beneath the tumor. This is commonly used for invasive vulvar cancer when the cancer is limited to one area. Depending on the tumor’s location and depth, nearby lymph nodes may also be checked or removed.

Complete radical vulvectomy

A complete radical vulvectomy removes the entire vulva, deeper underlying tissues, and sometimes nearby lymph nodes. This surgery is now much less common than it used to be because surgeons often use more conservative approaches when safe. Still, it may be needed for advanced or extensive disease.

Lymph node surgery

Because vulvar cancer can spread to lymph nodes in the groin, some patients need lymph node evaluation. A sentinel lymph node biopsy removes the first lymph node or nodes most likely to receive drainage from the tumor. If those nodes are clear, more extensive lymph node removal may be avoided. If cancer is found, additional treatment may be recommended.

What Happens Before a Vulvectomy?

Before surgery, the care team confirms the diagnosis, maps the affected area, and evaluates whether cancer has spread. This may include a pelvic exam, vulvar biopsy, imaging tests, blood work, anesthesia evaluation, and discussion of medications. Patients may be asked to stop certain blood thinners, avoid smoking, arrange transportation, and plan for help at home.

This is also the time to ask direct questions. Good questions include: How much tissue will be removed? Will lymph nodes be checked? Will I need reconstruction? Will I have a catheter or drains? How long should I avoid sex, exercise, or sitting for long periods? What symptoms should make me call the doctor?

What Happens During the Procedure?

A vulvectomy is usually performed in an operating room under general anesthesia or regional anesthesia. The patient lies in a position that allows the surgeon to safely access the vulva and groin area if lymph node surgery is planned.

The surgeon marks the area to be removed, makes one or more incisions, and removes the abnormal tissue with a planned margin. If cancer is involved, the tissue is sent to pathology to confirm the diagnosis, margin status, and other important details. If lymph node surgery is needed, the surgeon may inject dye or use a tracer to locate sentinel lymph nodes.

After the tissue is removed, the surgeon closes the wound with stitches or uses reconstructive techniques such as skin flaps or grafts. Some patients need a urinary catheter for a short time. Others may have drains placed near the groin if lymph nodes are removed. The length of surgery varies widely depending on how extensive the procedure is.

Recovery After Vulvectomy

Recovery depends on the type of vulvectomy, whether lymph nodes were removed, and whether reconstruction was performed. Some people go home the same day after a limited procedure. Others stay in the hospital for monitoring, pain control, wound care, and help with walking or urination.

Common early symptoms include swelling, bruising, soreness, spotting, numbness, pulling sensations, and fatigue. The vulvar area has moisture, friction, and natural movement, so healing can feel slower than healing from a cut on the arm or leg. That does not mean anything is wrong; it means the body is trying to repair a high-traffic neighborhood.

Wound care

Patients are often taught to rinse the area gently with water, use a peri bottle or sitz bath, pat or air-dry the area, and avoid rubbing. Keeping the incision clean and dry is important, but “clean” does not mean scrubbing like a kitchen sink. Gentle care wins.

Activity limits

During recovery, patients may need to avoid heavy lifting, long periods of sitting, cycling, swimming, tub baths unless approved, tampons, and sexual intercourse until the surgeon confirms healing. Loose cotton underwear, soft clothing, and sitting on one hip or using cushions can help reduce friction.

Pain control

Pain may be managed with prescription medicine at first, then over-the-counter pain relievers if approved by the care team. Stool softeners may be recommended because constipation after pelvic surgery is nobody’s idea of character building. Drinking fluids, eating fiber, and walking gently can also help.

Possible Risks and Complications

All surgery has risks. Vulvectomy risks may include bleeding, infection, wound separation, delayed healing, scarring, pain, numbness, changes in urination, sexual discomfort, narrowing of the vaginal opening, emotional distress, or changes in body image.

If lymph nodes are removed, there may also be a risk of leg swelling called lymphedema, fluid collection, groin wound problems, or numbness in the upper thighs. Patients should call their healthcare provider for fever, worsening pain, heavy bleeding, foul-smelling drainage, increasing redness, trouble urinating, calf swelling, shortness of breath, or any symptom that feels suddenly worse.

Sex, Intimacy, and Body Image After Vulvectomy

Vulvectomy can affect sexual function, sensation, confidence, and the way a person feels in their body. These effects vary. A small partial vulvectomy may cause limited changes, while a radical surgery can have a much larger impact on sensation, arousal, comfort, and appearance.

Many patients benefit from pelvic floor physical therapy, sexual health counseling, lubricants, vaginal dilators if recommended, pain management, and open communication with a partner. Emotional recovery is not a luxury add-on; it is part of healing. A person can be grateful for cancer treatment and still grieve physical changes. Both can be true at the same time.

Alternatives and Additional Treatments

Not every vulvar condition requires a vulvectomy. Depending on the diagnosis, alternatives may include topical medications, laser therapy, local excision, radiation therapy, chemotherapy, immunotherapy in select cases, or active surveillance. For vulvar cancer, the treatment plan depends on stage, tumor size, lymph node status, overall health, and patient preferences.

In some advanced cases, radiation or chemoradiation may be used before surgery to shrink a tumor and reduce the amount of tissue that must be removed. In other cases, radiation may be recommended after surgery if cancer is found at the margins or in lymph nodes.

When to Talk With a Doctor

Anyone with persistent vulvar itching, burning, bleeding, sores, color changes, thickened skin, wart-like growths, pain with urination, pain during sex, or a lump that does not go away should make an appointment with a healthcare provider. Many vulvar symptoms are caused by noncancerous problems, but guessing is not a diagnostic strategy. The vulva deserves better than “let’s wait and see forever.”

Early evaluation can lead to earlier treatment, smaller surgeries, and better outcomes. If a biopsy is recommended, it is because looking at tissue under a microscope is the most reliable way to know what is happening.

Common Patient Experiences After Vulvectomy

Although every recovery is personal, many patients describe a few shared experiences after vulvectomy. The first is surprise at how emotional the surgery feels. Even when the operation is medically necessary and successful, it involves a private, sensitive part of the body. Patients may feel relief, fear, sadness, awkwardness, gratitude, frustration, or all of the above before breakfast. That emotional mixture is normal.

Another common experience is learning that wound care becomes part of the daily routine. Rinsing after using the bathroom, drying carefully, checking the incision, wearing loose clothing, and planning bathroom breaks can feel like a part-time job at first. Some patients find it helpful to create a small “recovery station” at home with a peri bottle, clean towels, unscented pads, prescribed ointments, pain medicine, stool softeners, and comfortable underwear. Organization cannot make healing instant, but it can make the day feel less chaotic.

Sitting may be uncomfortable for a while. Many patients experiment with positions: leaning to one side, reclining, using pillows, or standing for short tasks. Walking is often encouraged, but the pace may be slower than expected. This is not laziness. It is tissue repair. The body is busy doing construction work, and it did not ask for a motivational speech.

Urination can also feel different early on. Some people notice stinging when urine touches the incision. Rinsing with water during or after urination may reduce discomfort. If urination becomes difficult, painful in a worsening way, or impossible, that needs prompt medical attention.

Intimacy may take time to revisit. Patients often wonder when they will feel “normal” again. The honest answer is that normal may change, but comfort and pleasure can still be possible. Healing may involve patience, pelvic floor therapy, honest conversations, and a clinician who takes sexual health seriously. No one should be told to simply “be thankful” and ignore pain, fear, or loss of sensation.

Follow-up visits are another important part of the experience. The surgeon checks healing, reviews pathology results, discusses margins, and explains whether additional treatment is needed. These appointments can be stressful, especially while waiting for pathology reports. Bringing a trusted person, writing down questions, and asking for plain-language explanations can help.

Finally, many patients say they wish they had known that recovery is not perfectly linear. One day may feel better, the next may feel tender and exhausting. Minor swelling or pulling can come and go. The goal is gradual progress, not a dramatic movie montage where someone runs up a mountain two weeks after surgery. Healing after vulvectomy is quieter, slower, and deeply personal. Support matters, and asking for help is not weakness. It is smart recovery planning.

Conclusion

A vulvectomy is a major topic, but the basic idea is simple: it is surgery to remove unhealthy, precancerous, or cancerous tissue from the vulva. The type of vulvectomy can range from a small partial procedure to a more extensive radical operation, and the plan is based on diagnosis, tumor location, depth, lymph node risk, and overall health.

Modern care aims to remove disease while preserving as much healthy tissue and function as possible. Recovery may involve wound care, activity limits, emotional adjustment, and careful follow-up. If you or someone you love is facing this surgery, clear questions, compassionate care, and realistic expectations can make the path less overwhelming.