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Types of surgery

Read about the different types of surgery for vaginal cancer.

How your surgeon decides on your operation

The amount of surgery you need depends on the stage of your vaginal cancer. The stage tells you how big it is and how far it has spread. Your type of operation will also depend on where the cancer is in your vagina.

Your surgeon might not be able to tell you the exact stage of your cancer until after surgery. 

There are a number of different operations for VAIN and vaginal cancer. Some of the operations for vaginal cancer are major surgery.

Vaginal intraepithelial neoplasia (VAIN) means that there are abnormal cells in the inner lining of the vagina. VAIN is not cancer.

Women with severe abnormal cells usually have treatment to prevent it from developing into cancer. One of the possible treatments is laser therapy.

The doctor uses a laser beam (a narrow beam of intense light) to destroy the areas of abnormal cells. This treatment can work well even for large areas of VAIN.

The doctor usually used a local anaesthetic to numb the area in the vagina before it is treated. 

This operation might be used to treat VAIN or for small stage 1 cancers. The surgeon cuts away the cancer, and also removes a border of healthy cells from all around the abnormal area. If the border is completely free of cancer cells, it’s called a clear margin.

Your surgeon might use a spinal anaesthetic or a general anaesthetic to carry out the treatment.

Diagram showing a wide local excision for vaginal cancer

An operation to remove the upper part of the vagina is a partial vaginectomy. A total vaginectomy is an operation to remove the whole vagina. The operation you have depends on how much of the vagina is affected by the cancer.

If you need to have your vagina removed you could ask about the possibility of vaginal reconstruction. A reconstruction uses skin and muscle from other parts of your body to create a new vagina. It may not be possible for some women to have this. Or some women may decide they don't want to have this extra surgery. 

You need a bigger operation if your cancer has spread through the wall of your vagina and into the surrounding tissues. You have part or all of your vagina removed as well as: 

  • your womb (uterus)
  • all the tissues holding your womb in place
  • all the lymph nodes around the womb

This is called a radical hysterectomy or Wertheim's hysterectomy. The surgeon removes the surrounding tissues in case cancer cells have spread there. Removing them helps to prevent the cancer from coming back in your bowel, bladder or nearby lymph nodes.

Diagram showing radical hysterectomy including removal of the vagina

You will be in hospital for about 3 to 10 days. You need to recover at home for at least another 6 weeks or so.

Removing the ovaries

If you have had the menopause, your doctor may suggest taking out your ovaries as well. The cancer doesn’t usually affect the ovaries. But some surgeons think it’s worth doing because it removes the risk of cancer of the ovary in the future. You are no more at risk of ovarian cancer than a woman who has not had cancer of the vagina. 

Some women agree with the surgeon to reduce any possible risk. Other women would rather not have their ovaries removed as well as their womb. There is no right or wrong way to feel about this. You may want to take some time to talk this over with your specialist, your cancer nurse, or a close family member or friend.

If you have not had the menopause, it may be possible to leave your ovaries. Removing them would put you into a premature menopause.

Your doctor might suggest you take hormone replacement therapy (HRT) if you need to have your ovaries removed. This could prevent menopausal symptoms and bone thinning (osteoporosis).

You need a major operation if the cancer has spread outside your vagina to nearby lymph nodes and organs. You have a radical hysterectomy which would remove:

  • your vagina
  • your womb (uterus)
  • all the tissues holding your womb in place
  • all the lymph nodes around the womb

As well as a hysterectomy, your surgeon might need to remove your:

  • bladder
  • rectum (back passage)
  • another part of the bowel

If all these organs are removed, it is called a total pelvic exenteration. This isn’t a very common operation for women with vaginal cancer.

Diagram showing the organs removed with an operation called a total exenteration

These operations are very big and are difficult to cope with. It can be especially difficult if you have your bladder and bowel removed along with your vagina and womb. 

It can take a long time to recover afterwards. It could take about 6 months to get over the changes to your body. Some women say that it can take much longer to adjust completely. 

This type of surgery is more often used for locally advanced cervical cancer. So you can find more detailed information about pelvic exenteration in the cervical cancer section. 

Having your bladder removed

Without your bladder, you need another way of collecting and storing urine. The most common way of doing this is to have an opening formed on the outside of the tummy (abdomen). This is called a urostomy. You wear a waterproof bag over the urostomy to collect your urine. You empty the bag as often as you would normally go to the toilet to pass urine.

There is more detailed information about having a urostomy in the bladder cancer section.

Having your rectum and part of your bowel removed

You will need a new opening for your stools (faeces) if your back passage (rectum) is removed. Your surgeon makes an opening in your abdomen, brings the healthy end of the bowel to the outside and stitches it in place. This is called a colostomy. You wear a bag over the colostomy to collect your faeces.

During this operation, your surgeon will also remove the lymph nodes around the bowel. This is in case the cancer has spread there.

Occasionally, the surgeon may not know whether you need a permanent colostomy until you have the operation to remove the cancer. You might only need a temporary one.

A temporary colostomy can be put back (or reversed) when the bowel has healed. It may not be clear how big the tumour is, or how much of the bowel is affected until you have surgery. Your surgeon will explain this before the operation.

Your surgeon will not do a permanent colostomy unless it is absolutely necessary. You will be able to ask questions about why you need this type of operation before you sign the consent form.

There is more detailed information about having a colostomy in the bowel cancer section.

If you need to have your vagina removed you could ask about the possibility of vaginal reconstruction. A reconstruction uses skin and muscle from other parts of your body to create a new or vagina. It may not be possible for some women to have this and some women may decide they don't want to have this extra surgery. 

One of the aims of reconstruction is to try to make vaginal intercourse possible after surgery. A new vagina can take some time to get used to. The sensation might be different and you will need to use an artificial lubricant. Depending of what tissue is used, the lining of the new vagina might not make the mucus it would naturally make.  

Ask you surgeon about the benefits and risk of this surgery.

Diagram showing a radical hysterectomy with a reconstructed vagina

Emotional effects

Vaginal surgery is probably one of the more difficult types of surgery for women to cope with emotionally and physically. It is one of the most private parts of a woman's body and plays a very big role in sexual life. 

You might find it useful to talk to someone about the effect that surgery is having on your everyday life, both emotionally and physically. Ask your doctor or nurse what support is available in your area. You could ask about counselling if you think this might help. 

With a rare type of cancer it can be difficult to find women at the same hospital, going through a similar experience to you. You could contact other national organsations and charities, or join an online discussion group.  

Last reviewed: 
15 Sep 2015
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