Cancer can affect any part of the body, including the reproductive system. When surgeons have to remove part or all of the vagina due to cancer, reconstruction surgery offers a way to maintain vaginal function.
The surgical removal of the vagina, or parts of it, is known as a vaginectomy. It is a procedure doctors use to address structural irregularities or treat pelvic conditions or cancer.
Removing the vagina does not mean an end to a person’s sexuality. Reconstructive surgery, called vaginoplasty, can repair affected areas or create a new vagina using tissues from other body areas.
This article looks at vaginal reconstructive surgery after a cancer-related vaginectomy.
Vaginal reconstructive surgery rebuilds the structures of the vagina using the body’s own tissues.
It can allow those affected by gynecological cancer to continue to experience sexual intercourse and, when a functional uterus is present, regular menstruation.
According to the
Vaginectomy is a treatment option for cancers that do not respond to radiation by itself, are recurrent, or are in advanced stages.
Vaginoplasty is not always necessary after vaginectomy. However, many people feel the procedure helps them maintain a sense of well-being and a positive self-image.
A person who has a vaginal reconstruction after cancer usually has general anesthesia. They can expect a hospital stay, fluid therapy, vitals monitoring, and airway preservation.
The steps of the vaginoplasty will vary depending on how much of the vagina doctors are repairing and what procedure they select.
A surgeon can perform some operations through laparoscopy, while others require more invasive methods or multiple surgical donor sites.
Regardless of the procedure, the surgeon recreates all or part of the vagina while also repairing any areas of the body that donate tissue. They will place a urinary catheter to help keep pressure off the vaginal canal.
- Sigmoid vaginoplasty: Routinely conducted through laparoscopic surgery, this uses small incisions and camera-guided techniques instead of open surgery. The surgeon rotates a detached portion of the sigmoid colon down to form the new vaginal canal.
- Genitocrural or pudendal thigh flap vaginoplasty: Surgeons use skin sections from the groin crease where the inner thigh meets the genital area to recreate missing parts of the vagina. Unlike sigmoid vaginoplasty, this involves multiple external surgical sites.
- Buccal mucosa vaginoplasty: This is a vaginal reconstruction using the tissues of the mouth and cheek. It requires facial surgery in addition to pelvic surgery.
- Peritoneal vaginoplasty: Similar to sigmoid vaginoplasty, this uses the lining of the intestines to recreate the vagina.
The surgical team should carefully explain how to prepare for vaginal reconstruction surgery. Some procedures may require hair removal, particularly if they involve operating on exterior areas of the groin or vagina.
People may also need to change their medication routines and stop taking dietary supplements. If they smoke, they will need to stop a few weeks before surgery.
Additional consultations with
In the days before the procedure, fasting requirements can help reduce anesthetic complications. Hospital staff may also advise a person to wear comfortable clothes and make travel accommodations for the day of the procedure.
After a brief hospital stay to ensure proper pain management and monitoring for postsurgical complications, recovery from vaginal reconstruction surgery occurs at home. A person can speak with a doctor about how long it will take to heal fully.
After surgeons remove the initial stent, using a vaginal dilator or having regular sex — when a doctor says it is safe to resume sexual activity — may be necessary to keep the vagina open.
The American Cancer Society (ACS) notes that using a dilator for a
According to the
People can speak with a doctor to find out more about the type of douche to use, how often to clean, and instructions.
Resuming sexual activity
Resuming sexual activity will depend on recovery progress. However, people may need to wait several months.
It will not be possible for the vagina to produce significant lubrication during sex, though sigmoid vaginoplasties provide some moisture from the intestinal graft tissue. This means that people will need to apply lubricants.
It is important to note that a neovagina or a vagina repaired with other tissues will not have the same level of sensation or function as a presurgery vagina.
However, there will still be sensations. Sex may produce an unfamiliar stroking feeling that, in time, can translate to sexual stimulation. People may need to try different sexual positions to find the one that feels best.
Having hair inside the vagina from grafted tissue is natural. Minor bleeding or spotting from penetration is also common and not a cause for alarm. A doctor will need to address any heavier bleeding.
Despite how complex vaginal reconstruction surgery may seem, people generally experience a positive outcome.
A 2017 retrospective study published in the journal Archives of Plastic Surgery reports that sigmoid vaginoplasty is a safe, well-accepted operative method, with over 70% of people reporting excellent satisfaction ratings.
However, in a 10-year follow-up study on vaginoplasty due to vaginal carcinoma, the authors indicated that genitocrural flap reconstruction had satisfactory outcomes and fewer complications compared with sigmoid vaginoplasty.
According to a 2020 literature review in Genital Aesthetic Surgery, researchers have also noted excellent cosmetic and functional results for vaginoplasty done with buccal mucosa.
No surgery is without possible risks.
Those associated with vaginal reconstruction surgery include:
The exact cost of vaginal reconstruction surgery will depend on the procedure, the specialists involved, where it occurs, and how long it takes.
If a person has health insurance, it should cover the procedure.
Helping pay for surgery
For those without insurance, options to help pay for vaginal reconstruction surgery include:
- personal bank loans
- credit lines
- payment plans through the surgeon’s office
- financial assistance programs
People may wish to seek sex therapy after this type of surgery. The
The cost of this therapy can depend on the professional’s training and qualifications and a person’s health insurance policy if they have one.
People can use the American Association of Sexuality Educators, Counselors, and Therapists’ online tool to find a sex therapist.
Vaginal reconstruction surgery after cancer can help maintain sexual function and regular menstruation.
Although surgery can be complex and involve multiple areas of the body, including donor sites such as the face or thighs, many people report overall satisfaction with vaginoplasty outcomes.