My Surgery: Vulvectomy Surgery Guide

You must come for your pre-admission appointment before your operation. If you don't come for your pre-admission visit, your surgery will be cancelled (unless you were given other instructions).

In the weeks before your operation, you will have a pre-admission appointment. This appointment could take 2 to 4 hours, or sometimes longer.

Pre-Admission Clinic
Toronto General Hospital
Eaton Building – Ground Floor, Room 400 
TGH Maps & Directions 

• You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
• You may also need an electrocardiogram (ECG) to check your heart and a chest x-ray to check your lungs.
• You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions you may have.
  • A pre-admission nurse will review your health history and give you information to prepare you for your surgery, including directions for cleaning your skin, eating before surgery, taking your medications and pain management.
  • A pharmacist will review your medications.
• Depending on your needs, you may also meet:
  • An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after surgery.
  • A member of the medicine team, if you have other complex health problems.
  • A Clinical Nurse Specialist (CNS), or Nursing Coordinator, who specializes in the care of patients having your specific surgery. They will review any preparation that is required before your surgery, plans for your discharge home after surgery and specific instructions regarding your recovery.

Stop drinking and eating by midnight on the night before your operation. Your stomach needs to be empty.

1. Drink only clear (see-through with no solids) fluids. Fluids that are OK to drink include:
   • Apple juice
   • Orange juice (without pulp)
   • Grape juice
   • Cranberry juice
   • Lemonade
   • Beef or chicken broth (no noodles or vegetables)
   • Jell-O
   • Popsicles
   • Pop (such as ginger ale, 7-Up, cola)
   • Water
   • Coffee and tea (with no milk or cream)
   • Do not have any solid foods (like meat, vegetables, bread) or milk products.
2. You may be asked to use an enema to clear your bowels before your operation.
3. Do not eat or drink anything after midnight (12 am) the night before your surgery. Your stomach must be empty when you are given the anesthetic (the medicine that puts you to sleep).
4. If your doctor has told you to take certain medications before surgery, take them with sips of water.

A nurse will prepare you for surgery in the Pre-Operative Care Unit. You may receive an injection of a blood thinner under your skin to prevent blood clots from forming during and after your operation. After that, you will be taken to the operating room for your operation.

On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.

• What will happen right after my operation?
• How will I feel after my operation?
• How can I take care of myself after operation?
• How long will I stay in the hospital?

You will wake up in the Post Anesthesia Care Unit (PACU) for a few hours. Once you are awake and stable, we will take you up to the Gynecology Surgical Oncology Inpatient Unit.

You will feel pain at the incision sites (vulva or groin). Your pain will be controlled with intravenous (IV) pain medication that is given to you through a vein by your health care team. This is followed by pain medication that you can take by mouth.

After your surgery you will have:

• A cut on your vulva that has been closed with sutures.
• An intravenous (IV) for fluids.
• An oxygen mask, if needed to help you breathe.

You may also need to have:

• A bladder catheter (tube) to drain urine from your bladder. Your doctor will decide when it can be removed. In some cases you may need to go home with a catheter. If you go home with a catheter, homecare nursing will be organized for you.
• JP Drain(s) in your groin incision (cut) if you had groin lymph nodes removed. This drains lymph fluid and may be left in place for several weeks. Homecare nursing will be organized to care for these drains

Breathing
Right after your operation, your nurse will ask you to breathe deeply and cough. An incentive spirometer will help you to do that. This brings air into your lungs and helps to prevent pneumonia.

Eating and drinking
Your bowel will not begin to work again until about 1 – 2 days after surgery. Your health care team will tell you when you are able to eat or drink. You will begin eating on the first day after your operation.

Activity
Most patients go home the day after surgery and therefore are up and walking. The first day after your surgery, the nurse will help you get out of bed and walk. Wiggle your toes and move your feet often while you are in bed. This helps to increase circulation in your legs and prevent blood clots.

Bathing
You will likely be able to shower in the first couple of days after surgery. Check with your doctor before taking a bath. The vulva can be a difficult area to keep clean. Using a perineal irrigation bottle after going to the bathroom can help you keep the area clean. This can be purchased from a drug store and your nurse can show you how to use it.

Constipation
You may experience constipation because of your surgery, the general anesthetic used to put you to sleep, and/or pain medication. You will be given stool softeners and laxatives to help with constipation. Try to walk as much as you can because walking helps you to pass gas and ease the discomfort.

Go to your nearest emergency department if you experience bleeding, fever, severe pain or shortness of breath.

You may have some side effects from the surgery. This is normal. These side effects may last for many months.

• Numbness or tenderness of your vulvar area.
• The skin removed during surgery was like padding to the area. Try sitting on pillows, a circle called a "doughnut", or something soft to feel more comfortable. Avoid wearing tight clothing over the sensitive area. Do not wear tight underwear.
• A change in direction of your urine stream or spraying urine.
• You may need to adjust your position on the toilet seat while you recover.
• Swelling of your legs.

If your lymph nodes were removed during your operation, your legs may swell. Lymph nodes control how your fluid moves in your body. To decrease swelling, raise your legs for several hours each day. For example, put them on 2 pillows when you are sitting. You may also need to wear special support hose when you are not able to raise your legs. Consult your doctor if this happens.

Keeping your incision (cut) clean is very important. This will help your healing and recovery. Always wash your hands before and after your vulvar care. Use clean towels and washcloths each time.

• After urinating or a bowel movement, wipe yourself from front to back. This will help keep your incision clean. Before you go home from the hospital, your nurse will give you a spray bottle for cleaning yourself.
• Before you go home from the hospital, your nurse will give you a sitz bath. Take it home with you. Do a sitz baths 3 times a day and after each bowel movement. Do this until your incision is healed.
• Keep your vulvar area as dry as possible. Carefully pat dry the area after each sitz bath. You can also use a hair dryer on a cool setting. If possible, avoid wearing underwear.
• Make sure your JP Drain(s) are secured to your clothes so they don't pull. Check your JP drain every day and write down the amount of fluid you have on the "Output Record Form" that the nurse gave to you after your operation. If your doctor thinks you may need help keeping your incisions clean, they may arrange home care nursing visits for you.

Avoid wearing pantyhose or girdles. They are tight and keep air from circulating in your vulvar area. This can increase the chance of infection.

• During the day, wear loose clothing and cotton underwear.
• Don't wear underwear when you go to sleep.
• Use natural soaps (glycerin) or just warm water when cleaning the vulvar area. Don't use bubble bath or perfume soaps.
• Don't use talc (baby powder) or lotion on your vulvar area.

You can usually have sex about 6 to 8 weeks after your surgery. Your vulvar area has to heal completely first. Your doctor will tell you when you have healed and are ready to have sex.

When you first start to have sex again, your vulvar area may feel numb or tender. This is normal. Remember that your vulva may have changed but your inside (your vagina) is the same. If your clitoris was removed, you will have less feeling or no feeling in that area. It is important that you and your partner get pleasure from touching other areas of your body. Other sensitive areas include: lips, ear lobes, breasts, and inner thighs. Keep an open mind. Touching, cuddling and stroking can give you great pleasure. After sexual activity, always empty your bladder (pee) and clean and dry your perineal area (the area between the anus and vagina).

Go to your nearest emergency department if you experience bleeding, fever, severe pain, or shortness of breath.

Call your clinical nurse specialist at 416 340 4800 ext. 3674 if you notice:

• An increase in pain.
• An increase in redness around your incision (cut).
• A bad smell coming from the area.
• That your skin in that area is warmer than usual.
• You have a temperature of 38 °C or 100 °F.
• You have pus (yellowish or white liquid) coming from your incision.

If you have any questions, please call your clinical nurse specialist at 416 340 4800 ext. 3674. For evenings, weekends and holidays, please call the Gynecology Surgical Oncology Inpatient Unit at 416 340 3521 and ask to speak with nurse in charge.

Before you go home from the hospital, you will get the date of your follow-up appointment.