This advice is intended as a general guide, as everyone is different. You will be given the opportunity to ask your nurse any questions before leaving the ward. You may also receive additional information which is relevant to you and which will help your recovery. If you feel there is information that you would like that you haven’t been given, please just ask.
The surgery you have had is ………………………………………………………………
This is to remove …………………………………………………………………………….
How long will it take to recover from my surgery?
The rate of recovery following surgery for pre-cancer or cancer of the vulva, especially when groin nodes have been removed, depends on each individual and to a large extent, on your general state of health before your surgery. It is important to resume your normal activities gradually and limit what you do by how tired or uncomfortable you feel. Following wide local excision (WLE), most patients are back to their normal levels of activity by six weeks. However, following other surgeries for vulva cancer, it can take at least two to three months to recover from your surgery, sometimes longer. Most women say they start feeling their ‘normal’ selves after three to six months.
Rest and exercise
Listen to your own body and use your common sense. Do not push yourself too hard. Accept help from others when it is offered.
Gradually increase your activity each day and continue with the advised exercises. Some exercise is important because sitting for long periods can cause ankle and foot swelling and can increase your risk of deep vein thrombosis. You will continue to feel tired so continue to rest when you can.
Walking is an excellent way to exercise. Gradually increase the length of your walks but only walk a distance you are comfortable with. You should not swim until your bleeding has stopped and your wound(s) have completely healed.
Following vulva surgery and/ or groin node surgery-
You can do light household duties such as dusting and making a cup of tea. After two weeks you can gradually start to do more and by six weeks most women are back to their normal levels of activity with the exception of heavy or prolonged lifting or strenuous sports. You should therefore avoid excessive pushing, pulling or stretching, which includes heavy housework (vacuuming, ironing, mopping floors etc.) for up to 12 weeks after your surgery. Avoid heavy or prolonged lifting, you shouldn’t carry more than a three pint kettle. Allow children to climb onto your lap whilst you are already sitting rather than lifting them up. You will continue to feel tired so continue to rest when you can and gradually increase the amount of exercise you do. Some exercise is very important because sitting for long periods can cause ankle and foot swelling and can increase your risk of deep vein thrombosis. You should also continue with the advised exercises. Walking is an excellent form of exercise. Gradually increase the length of your walks but only walk a distance you are comfortable with. You should avoid high impact exercise (e.g. gym, jogging, and aerobics) for 12 weeks after your surgery. You should not swim until your bleeding has stopped and your wound(s) have completely healed.
Wound Care/Hygiene
Vulva wounds-
Once at home it is important to continue to shower ideally twice daily to keep your wound clean. After washing, gently pat dry your wounds with a clean soft towel (a small flannel may help to reduce the amount of laundry). Keeping your wound clean and dry can help to prevent infection. If you have a hand held shower head you can use it on a cool and low pressure setting and let the water run over the vulva.
We would advise that you also clean your vulva after toileting. If you are experiencing discomfort and stinging when passing urine due to the acidity of urine coming into contact with the wound, pouring a lukewarm jug of water slowly over the wound while sitting on the toilet might ease your discomfort. You may need to repeat this a few times. Some patients find it easier using a ‘Sitz’ bath (a plastic receiver that fits over the toilet and allows you to soak just your buttocks and genital area). If you can’t buy one locally they can usually be purchased online.
After washing it is important to gently pat your wound dry, try to avoid rubbing the area as this may cause discomfort and irritation. The area should be dry before getting dressed. When you are at home, try to expose the area as much as possible. This can be done by not wearing underwear for short periods of time or overnight. You should also change sanitary towels regularly to help keep the area clean and dry.
A district nurse may be organised to assess your wound once you are discharged home and will carry out wound care if needed. It is normal to feel tingling and pulling around the area of surgery as your wound(s) goes through stages of healing. It may take some time for the wound to heal completely. Although vulva stitches are dissolvable they can become tight and can be removed by the district nurse after seven days depending on how well the wound has healed.
Groin wounds-
If your wounds are closed and clean leave them uncovered to aid healing. It is common for these wounds to open or leak and frequent dressings changes may be necessary, your district nurse will support you with this.
General-
Due to the location of the wound/s it is relatively common that the wound/s may show signs of infection despite frequent washing, and your best efforts to keep it clean. If you experience any redness, heat, tenderness or offensive discharge from your wound(s) when you are at home please ask your district nurse/GP to swab the wound. It is likely that they will prescribe you a course of antibiotics.
If you or your district nurses require any information/support regarding wound care, please contact the ward directly and ask to speak to one of the nursing staff. Occasionally patients may need to be re-admitted into hospital if the wounds become difficult to manage.
Medication
You will take home the medicines you brought in with you. We will provide any extra medicines that you may need, such as pain relief, laxatives, anti-sickness medication or antibiotics. Use the medication as directed. If you are taking pain relief medicine such as morphine or sleeping pills, do not drink any alcohol and do not drive. Contact your GP with any side-effects from your medication.
Diet
Try to eat a healthy balanced variety of foods with plenty of fresh fruit and vegetables. Introducing high fibre food including wholemeal bread, bran flakes, beans and pulses along with plenty of fluids will help prevent constipation. You should drink at least eight glasses of water (or non-sugary drinks) every day. Protein rich foods including fish, eggs, meat, hearty green vegetable and beans and pulses will help with the healing process. Avoid fatty foods, excessive alcohol, cakes and sweets if you do not want to gain weight. Your surgery won’t make you put on weight but you must control your calorie intake whilst you are less active. Some patients have a poor appetite following surgery which can be for many reasons. If this applies to you please consult your GP who can refer you to a dietician or prescribe supplements.
Constipation
Pain relief medication, reduced activity, having surgery and changes in your appetite can all affect your bowel function. If you are constipated following your discharge from hospital it is important that you try to address it as soon as possible. Try to increase your fluid intake and eat a well-balanced diet with foods rich in fibre e.g. wholemeal bread, bran flakes, beans and pulses.
If you have not moved your bowels for three days, please contact your GP or district nurse who may give you some medication to help.
Fatigue
It is common to feel tired and sometimes irritable and frustrated after surgery. Even simple everyday tasks that we usually take for granted, such as having a shower, might make you feel exhausted. This is very common and is usually temporary; it will improve with your recovery. In the meantime a good diet, exercises, relaxation and help from your family and friends can all ease the fatigue and its impact on your everyday life. Your sleeping patterns may change due to a change in routine however it will return to normal along with your strength and stamina.
Sex and intimacy
Following vulval surgery, some patients worry about sexual intercourse being painful and are concerned about resuming sexual relationships. We would usually recommend no sex for at least the first six weeks after surgery to allow healing. However it can take several months for the vulval area to heal completely. Do not use tampons until your vulval wound is fully healed.
It can also take time for energy levels and sexual desire to improve. During this time it may feel important for you and your partner to maintain intimacy, despite not having sexual intercourse. Once you feel ready gentle penetration is advised, lubrication jelly and vaginal moisturisers can be used which can be prescribed by your G.P or bought over the counter. You may also find that you feel a little numb during penetration however this should improve with time. It can still be possible to have an orgasm, although this is less likely if the clitoris is removed.
After some surgery intercourse can become difficult due to tightness and scarring as your vagina may be narrower and shorter. Using a vaginal dilator may be recommended to help manage these changes. A vaginal dilator is a tube shaped device that’s used to stretch your vagina. Vaginal dilators come in kits with different sizes ranging from small (about the size of a finger) to large. You’ll be advised to start using the dilator once your wound has started to heal. You will start with the smallest and slowly increase the size of the dilator over time as you feel more comfortable. Your Specialist Nurse can provide specific advice and support that’s right for you.
Having vulva surgery can have an impact not only on your physical relationship with your partner but can also affect you both emotionally. If you feel that you or your partner are struggling or have any questions related to your surgery, please contact your key worker.
Work
The right time to return to work will depend on your physical as well as your emotional recovery. When you return to work will also depend on the type of job you do. Remember that you have had a major surgery and time is needed to allow the healing of your wounds. Any job requiring heavy lifting may take a bit longer to return to, but you are the best judge as to how you feel. It is advisable to take a minimum of six weeks off work to adjust to your diagnosis and treatment, although it may be longer if you have any complications. It may be helpful to talk to your employer for advice and support. Macmillan can also provide booklets on returning to work and support with any money worries.
Driving
It is acceptable to go anywhere as a passenger in a car but if you are travelling long distances, ensure you stretch your legs regularly. It is important to consider the safety of yourself and others before driving – ensure you have stopped medication that may affect your driving ability. From a surgical point of view we recommend you don’t drive for at least six weeks after your surgery. You need to be sure that you are able to fully concentrate, move without pain and be able to perform an emergency stop before resuming driving. You will also need to check with your own insurance company that you have insurance cover before you start driving again, you can also contact the DVLA for further information.
Getting Emotional Support
Patients have often reported feeling isolated, scared, and lonely when they were first discharged home. It is common to feel frustrated at not being able to do the things you want to do. It is sometimes difficult for family and friends to understand how you are feeling.
It may be useful to refer back to the MacMillan booklet on vulva cancer as there are strategies within the booklet that may be helpful. It is very important to talk about your feelings, if you find this difficult you could join an on-line support group. If these feelings persist you should seek help or support from your local Gynaeoncology Clinical Nurse Specialist /key worker.
Follow up
You will usually be given a follow up appointment before your discharge from the hospital. If the histology (tissue) results from your surgery are not available before you are discharged home you will be given the results when you return to clinic.
All results are discussed at our once weekly Multi-Disciplinary Team meeting (MDT). MDT members include: Gynae-oncology Surgeons, Histo-pathologists, Radiologists, Medical Oncologists, Clinical Oncologists and Nurse Specialists. The health care specialists will talk about the treatment they feel is best for your individual situation. This will then be discussed with you to decide and appropriate follow up arranged.
When to call a Doctor
Seek medical attention if any of the following occur:
- Severe pain not controlled by pain relief medication
- Fever, shaking or chills or other signs of fever
- Signs of wound infection including increased redness, swelling, tenderness, warmth or drainage from the wound
- Offensive smelling discharge or odour from wound
- Excess bleeding
- Persistent vomiting with the inability to tolerate food and fluids
- Constipation for more than three days
- Severe pain in either calf or leg or sudden onset shortness of breath or chest pain
- Problems passing urine and/or urinary problems
What symptoms should I look out for?
If you have any of the following symptoms, please contact your GP, Gynaeoncology Nurse Specialist or hospital and request a review appointment:
- Persistent itching and/or soreness of the vulva skin
- A new change in colour of the vulva skin
- A noticeable lump or swelling on the vulva
- A noticeable lump in either groin.
Advice after discharge
If you have any questions or concerns once you are discharged, then please contact us on the numbers provided. Hopefully we will be able to deal with this over the telephone. If your problems require a physical assessment the nurse will arrange for you to be reviewed as soon as possible, we may advise you to attend your GP or local hospital. If you are admitted to another hospital before or after your surgery, could you or a family member, please inform the Queen Elizabeth Hospital by contacting your consultant’s secretary.