Other Gynecologic Cancer Surgeries
Treating gynecologic cancer can sometimes cause some very visible changes to a woman’s anatomy that can have a direct effect on body image and sexuality. Cancer of the vulva is the one external gynecologic cancer that can directly be seen (with a mirror) and can have visible scarring in this very delicate area. Fortunately, this is not very common. Vaginal cancer, although not technically an external visible cancer can have significant effects on sexual intercourse. Also, some gynecologic cancer surgery will either permanently or temporarily leave bowel or bladder function draining from the abdomen (through an “ostomy”) which is often a life altering event for a patient with cancer. Care and support of the cancer team and better understanding of these surgeries will be very helpful in better dealing with the changes on sexuality.
Vulvectomy — This is the partial or complete removal of the vulva, the soft area around the vagina which helps to cushion this area. The anatomy includes the labia and the clitoris and the tissue between the vagina and anus. If preinvasive disease is found and treated, often surgery will not include removing any of the structures including the labia and clitoris. That means you should be able to resume sexual practice without a problem once healed. Surgical scars, though, may cause you concern about the way your vulva looks.
If the disease is more advanced, or depending on the actual location of the tumor within the vulva, more of the vulva and the labia may be removed. Rarely the clitoris will be removed. If lymph nodes are also removed from the groin which is frequently done with a measurable tumor, the vulva and labia may swell. There may also be swelling — either temporary or permanent — in the area of the inner thigh.
If the disease has spread, you may need treatment with radiation. Radiation after surgery can cause swelling, delay wound healing, and cause vaginal discharge. It can also make intercourse uncomfortable. Using vaginal lubricants and vaginal dilators may help.
Vaginectomy — This procedure removes all or part of the vagina. It’s used to treat early vaginal cancer or to treat cancer that has spread from the cervix or uterus down into the vagina. Typically, just the upper part of the vagina is removed. In that case, you should notice little or no effect on intercourse or sexual pleasure. For advanced or recurrent cancer, the entire vagina may be removed. A new vagina can be reconstructed from skin grafts. This will limit sexual pleasure since many of the nerves have been disrupted. But it will allow you to have sexual intercourse with your partner which can be a strong part of maintain intimacy.
Ostomies — These are surgical diversions of the bladder or the bowel so it empties outside the abdomen. Ostomies are usually due to obstruction of the bowel or ureter or due to destruction or removal of the bladder. The ureter is the tube that leads to the bladder from the kidney.
A colostomy diverts the colon through the abdomen. It is used in rare situations for advanced cancer. The site of the colostomy is chosen so the stoma bag can be applied without difficulty. A colostomy may be temporary or permanent. It depends on the surgical situation and amount of disease. It will not interfere with your sexual functioning. But it may affect the way you feel about your body image. It may also make you feel self-conscious if sounds or odors come from the colostomy. There are many products that can help to keep this from happening too often. Feeling comfortable with your body is part of feeling sexual. Some women use sexy clothing to cover areas that make them feel unattractive.
A urinary diversion brings the urine out of the abdomen. There are many different kinds of urinary diversions, some allow continence and others are not continent. The most common diversion is called an ileal conduit and is not continent. It is created from part of the small bowel to form apathway between the ureters and the abdomen. The opening, though, is through the abdomen which looks like a small piece of bowel that comes to the skin. A bag is worn that collects the urine which is frequently drained. Other diversion procedures use pieces of the small bowel and/or colon to make a new bladder. These are usually fairly continent and are drained by using a catheter which feeds into a small opening on the skin. Depending on the type of conduit, you may not need to wear an appliance bag. This will not interfere with sexual functioning. But you may need to get used to your new body. When bags are worn, it is also helpful to make sure the seal is tight and the bags are empty so that they do not come open or leak during sexual activity.