Most women feel shocked and upset by the idea of having surgery to the vulva. When these strong feelings are combined with the trauma of surgery, as well as all the emotions that go with having a cancer diagnosis, it is understandable that your sex life will be affected.

Surgery to a part of the body which is normally associated only with the most intimate and private areas of our lives – sexuality and womanhood – can evoke all kinds of feelings, from deep shame to fear and anger. It is not something any of us would choose, and yet you will have had to do this in order to do the best thing for your health. This is a hard choice to make. Vulvectomy can permanently alter the outward appearance of the body and is a change that many women may find hard to accept. It may have an effect on how you feel about your sexuality and womanhood, and may well affect your needs and wants in relation to your sex life.

Although the area of the operation can heal within about six weeks, the emotional effects will probably take much longer to deal with, and need gentleness and sensitivity from yourself and the people close to you.

Sex

Some women find that, at first, intercourse is not physically possible because of the way the wound has healed. For example, there may be some tightening or scar tissue from either surgery or radiotherapy. Things can be done to help with this, so it’s important to mention it to your medical team.

It may take some months before you really begin to enjoy sex again. Don’t be surprised if you feel very unsure about it. Talk to your partner and be as honest as you can about what you want and don’t want. Remember that you need to make yourself and your healing a priority. Allow yourself to say no to any kind of sexual contact that does not feel right.
How you approach looking at the vulval area after your operation will be very personal to you. Some women do not want to look at the area at all and this is very natural. Some women may want a nurse to be with them if or when they look for the first time. A nurse can explain what has happened to the area and can offer professional support and advice. Other women may want to look alone or with a friend, partner or relative. Whoever you choose, make sure it is someone that you trust and can talk to about your feelings. If you have never have looked at your vulva before the idea of doing so may seem strange.

Don’t force yourself to do things before you feel ready. If you do decide to look at the area where your surgery was it will probably seem odd, however well prepared you may have been. You may feel shocked, and this is understandable. If the labia have been removed, you may be able to see the opening to the vagina much more clearly. If the clitoris has been removed there will be an area of flat skin without the usual folds of the vulva.

Many women worry that if their clitoris has been removed they will not be able to have orgasms. This is not necessarily the case, although you may need to be patient while exploring different ways to reach a climax. Your doctor or nurse may be able to discuss this with you. You may also wish to speak to a sex therapist or counsellor experienced in this area. Our nurses, or the British Association of Sexual Therapists, can advise you on how to find counselling in your area.

For most women sex is more than just being able to feel aroused, or to have orgasms. It involves fundamental feelings about intimacy and about being able to give and receive love. If we are not comfortable with the way our bodies look, this may affect our feelings about sex.

Some women worry about being rejected by their partner, or any potential new partner, because of the changes to their body. Intimate sexual relationships always have the challenge of sharing your fears, worries and needs with your partner. The time after surgery or treatment to the vulva is no different. You may be surprised by the amount of tolerance and trust, tenderness and love that exists between you and your partner. However, sometimes difficulties may arise in your relationship. If this happens, you may find counselling helpful, either with your partner or on your own. If you can do this, you may find that it is possible to work through these feelings to a new closeness and understanding.

We have a section on sexuality and cancer, which you may find helpful.