About Your Vulvar Surgery

This guide will help you get ready for your vulvar surgery at MSK. It will also help you know what to expect as you recover.

Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will use it as you learn more about your recovery.

About your vulvar surgery

About your vulva

Vulva is another name for your external sex organs (genitals) (see Figure 1). Your vulva includes:

• The inner and outer lips of your labia.
• Your clitoris.
• The opening of your vagina.
• Your perineum (the area between your vulva and anus).

Vulvar cancer is cancer in any of the organs that make up your vulva.

Types of vulvar surgeries

Vulvar surgery can be done to treat vulvar cancer or to remove tissue that may become vulvar cancer. A surgery to remove all or part of your vulva is called a vulvectomy (vul-VEK-toh-mee).

There are several kinds of vulvectomies. The type of vulvectomy that you have will depend on how large your tumor is and whether it has spread to nearby lymph nodes. The types of vulvectomies are:

• Partial simple vulvectomy. With this type, a part of your vulva and the top layers of nearby tissue are removed.
• Partial radical vulvectomy. With this type, a part of your vulva and the deep layers of nearby tissue are removed (see Figure 2).

• Complete simple vulvectomy. With this type, your entire vulva is removed. Sometimes this is called a simple vulvectomy.
• Complete radical vulvectomy. With this type, your entire vulva, the deep tissue around it, and the surrounding lymph nodes are removed (see Figure 3).

Your healthcare provider will talk with you about the type of vulvectomy you’re having.

Some people choose to have reconstruction as part of their surgery. If you’re having reconstruction, a plastic surgeon may help with that part of the surgery.

Most people can resume their normal sexual activities after their incisions (surgical cuts) have healed. It will depend on the extent of your surgery and the areas of your vulva that were removed. Talk with your healthcare provider about your concerns about sexual activities after your surgery.

About your lymphatic system

Your lymphatic system is part of your immune system (see Figure 4). It’s made up of:

• Lymph nodes. These are small, bean-shaped structures located along your lymphatic vessels. Your lymph nodes filter out bacteria, viruses, cancer cells, and other waste products.
• Lymphatic vessels. These are tiny tubes (like blood vessels) that carry lymphatic fluid to and from your lymph nodes.
• Lymphatic fluid. This is the clear fluid that travels through your lymphatic system. It carries cells that help fight infections and other diseases.

Sometimes, cancer cells can enter lymphatic vessels and travel to nearby lymph nodes and other parts of your body. A sentinel lymph node is the first lymph node or group of nodes where cancer cells are most likely to spread. A sentinel lymph node is also called a sentinel node.

Your healthcare provider may do a sentinel lymph node biopsy during your surgery to check if cancer has spread. If so, you’ll have lymphatic mapping on the morning of your surgery.

Lymphatic mapping

Lymphatic mapping is a type of imaging scan. Before your scan, you’ll get an injection (shot) of a radioactive liquid. The pictures taken during your scan will show the flow of the radioactive liquid and which lymph nodes absorb it. Your surgeon will use this as a map to see the location of the sentinel node(s).

Where to go

Your lymphatic mapping procedure will be done in the Molecular Imaging and Therapy Service (MITS) at Memorial Hospital (MSK’s main hospital). The MITS is sometimes called Nuclear Medicine. The best entrance to use is the one at 1250 First Avenue, between East 67^thand East 68^th Streets.

The staff member at the front desk will direct you to the MITS. Check in at the Radiology Department reception desk next to the elevators.

If your surgery is at the Josie Robertson Surgery Center (JRSC), it’s best to park there and travel to Memorial Hospital for your lymphatic mapping. There’s a shuttle bus that will take you to Memorial Hospital and back to the JRSC after your mapping.

What to expect

First, you’ll get an injection of a small amount of a radioactive liquid near the site of the cancer. The injection might sting or burn. The radioactive liquid will travel to the sentinel node(s) so they can be seen later during your scan. After you get the injection, you can either stay in the hospital or leave for a while. It’s important to come back on time for your scan. Be sure to note the time you’re told to return.

When it’s time for your scan, a staff member will take you to the scanning room. You’ll lie on a narrow table while they take a series of pictures. Each picture takes 5 minutes.

It’s important to lie very still during each picture. You may feel uncomfortable staying in any position for 5 minutes. I fit helps, you can ask a staff member to track how much time you have left. Your scan will take 10 to 15 minutes total.

After your lymphatic mapping

If you’re having surgery at Memorial Hospital, a staff member will bring you to the Presurgical Center on the 6^th floor. If you’re having surgery at the JRSC, you can take the shuttle back to the JRSC.

Sentinel node biopsy

Your sentinel lymph node biopsy will be done during your surgery. Your surgeon will inject a small amount of blue dye near the site of the cancer. The dye will travel in your lymphatic fluid to the sentinel node(s), staining them blue.

Your surgeon will also use a small device that measures radioactivity from the liquid injected during your lymphatic mapping. Once they locate the sentinel node(s), your surgeon will make a small incision. The sentinel nodes will be blue from the blue dye, allowing your surgeon to see them. They’ll remove the sentinel node(s) so the Pathology Department can check to see if they have cancer cells.

Your skin, urine (pee), and bowel movements (poop) may be a bluish-green color from the blue dye. This usually lasts for 1 to 2 days after your surgery.

Groin lymph node dissection

A groin lymph node dissection is removal of most or all of the lymph nodes in your groin. The number of nodes varies from person to person. It can be done on 1 or both sides of your perineum.

If there are cancer cells in your sentinel lymph node(s), you may have a groin lymph node dissection during your vulvar surgery. Sometimes, you and your doctor might decide to do a groin lymph node dissection without doing a sentinel lymph node biopsy. This can happen if an imaging scan or other test showed cancer in your lymph nodes. Your doctor with talk with you to decide what’s best for you.

Getting ready for your surgery

This section will help you get ready for your surgery. Read it when your surgery is scheduled. Refer to it as your surgery gets closer. It has important information about what to do to get ready.

As you read this section, write down questions to ask your healthcare provider.

Getting ready for your surgery

You and your care team will work together to get ready for your surgery. Help us keep you safe by telling us if any of these things apply to you, even if you’re not sure.

• I take an anticoagulant (blood thinner), such as:
  • Aspirin
  • Heparin
  • Warfarin (Jantoven®, Coumadin®)
  • Clopidogrel (Plavix®)
  • Enoxaparin (Lovenox®)
  • Dabigatran (Pradaxa®)
  • Apixaban (Eliquis®)
  • Rivaroxaban (Xarelto®)
• I take an SGLT2 inhibitor, such as:
  • Canagliflozin (Invokana®)
  • Dapagliflozin (Farxiga®)
  • Empagliflozin (Jardiance®)
  • Ertugliflozin (Steglatro®)
• I take any prescription medicines, including patches and creams. A prescription medicine is one you can only get with a prescription from a healthcare provider.
• I take any over-the-counter medicines, including patches and creams. An over-the-counter medicine is one you can buy without a prescription.
• I take any dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
• I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
• I have sleep apnea.
• I have had a problem with anesthesia (A-nes-THEE-zhuh) in the past. Anesthesia is medicine to make you sleep during a surgery or procedure.
• I’m allergic to certain medicines or materials, including latex.
• I’m not willing to receive a blood transfusion.
• I drink alcohol.
• I smoke or use an electronic smoking device, such as a vape pen or e-cigarette.
• I use recreational drugs, such as marijuana.

About drinking alcohol

It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.

If you drink alcohol regularly, you may be at risk for problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.

If you drink alcohol regularly and stop suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these problems, we can prescribe medicine to help prevent them.

Here are things you can do before your surgery to keep from having problems.

• Be honest with your healthcare providers about how much alcohol you drink.
• Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
  • Get a headache.
  • Feel nauseous (like you’re going to throw up).
  • Feel more anxious (nervous or worried) than usual.
  • Cannot sleep.

These are early signs of alcohol withdrawal and can be treated.

• Tell your healthcare provider if you cannot stop drinking.
• Ask your healthcare provider questions about drinking and surgery. All your medical information will be kept private, as always.

About smoking

If you smoke, you can have breathing problems when you have surgery. Stopping for even a few days before your surgery can help.

Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.

About sleep apnea

Sleep apnea is a common breathing problem. If you have sleep apnea, you stop breathing for short lengths of time while you’re asleep. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes fully blocked during sleep.

OSA can cause serious problems during and after surgery. Tell us if you have or think you might have sleep apnea. If you use a breathing device, such as a CPAP machine, bring it on the day of your surgery.

Using MyMSK

MyMSK (my.mskcc.org) is your MSK patient portal. You can use it to send and read messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to make their own account so they can see information about your care.

If you do not have a MyMSK account, you can sign up at my.mskcc.org. You can get an enrollment ID by calling 646-227-2593 or your doctor’s office.

Watch How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal to learn more. You can also contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.

Within 30 days of your vulvar surgery

Presurgical testing (PST)

You’ll have a PST appointment before your surgery. You’ll get a reminder from your surgeon’s office with the appointment date, time, and location. Visit www.msk.org/parking for parking information and directions to all MSK locations.

You can eat and take your usual medicines the day of your PST appointment.

It’s helpful to bring these things to your appointment:

• A list of all the medicines you’re taking, including prescription and over-the-counter medicines, patches, and creams.
• Results of any medical tests done outside of MSK in the past year, if you have them. Examples include results from a cardiac stress test, echocardiogram, or carotid doppler study.
• The names and telephone numbers of your healthcare providers.

You’ll meet with an advance practice provider (APP) during your PST appointment. They work closely with MSK’s anesthesiology (A-nes-THEE-zee-AH-loh-jee) staff. These are doctors with special training in using anesthesia during a surgery or procedure.

Your APP will review your medical and surgical history with you. You may have tests to plan your care, such as:

• An electrocardiogram (EKG) to check your heart rhythm.
• A chest X-ray.
• Blood tests.

Your APP may recommend you see other healthcare providers. They’ll also talk with you about which medicine(s) to take the morning of your surgery.

Identify your caregiver

Your caregiver has an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged. They’ll also help you care for yourself at home.

For caregivers

‌  Caring for a person going through cancer treatment comes with many responsibilities. We offer resources and support to help you manage them. Visit www.msk.org/caregivers or read A Guide for Caregivers to learn more.

Fill out a Health Care Proxy form

If you have not already filled out a Health Care Proxy form, we recommend you do now. If you already filled one out or have any other advance directives, bring them to your next appointment.

A health care proxy is a legal document. It says who will speak for you if you cannot communicate for yourself. This person is called your health care agent.

• To learn about health care proxies and other advance directives, read Advance Care Planning for People With Cancer and Their Loved Ones.
• To learn about being a health care agent, read How to Be a Health Care Agent.

Talk with a member of your care team if you have questions about filling out a Health Care Proxy form.

Do breathing and coughing exercises

Practice taking deep breaths and coughing before your surgery. Your healthcare provider will give you an incentive spirometer to help expand your lungs. To learn more, read How To Use Your Incentive Spirometer.

Follow a healthy diet

Follow a well-balanced, healthy diet before your surgery. If you need help with your diet, talk with your healthcare provider about meeting with a clinical dietitian nutritionist.

Buy a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser, such as Hibiclens®

4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. You can buy a 4% CHG solution antiseptic skin cleanser at your local pharmacy without a prescription.

If you’re not having a sentinel lymph node biopsy or a groin lymph node dissection, you don’t need to buy a 4% CHG solution antiseptic skin cleanser.

7 days before your vulvar surgery

Follow your healthcare provider’s instructions for taking aspirin

Aspirin can cause bleeding. If you take aspirin or a medicine that has aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Follow your healthcare provider’s instructions. Do not stop taking aspirin unless they tell you to.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil. 

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Vitamin E, multivitamins, herbal remedies, and other dietary supplements can cause bleeding. Stop taking them 7 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read Herbal Remedies and Cancer Treatment.

2 days before your vulvar surgery

Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen (Advil^® and Motrin^®) and naproxen (Aleve^®), can cause bleeding. Stop taking them 2 days before your surgery. If your healthcare provider gives you other instructions, follow those instead.

To learn more, read How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil.

1 day before your vulvar surgery

Note the time of your surgery

A staff member will call you after 2 p.m. the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you the Friday before. If you do not get a call by 7 p.m., call 212-639-5014.

The staff member will tell you what time to get to the hospital for your surgery. They’ll also remind you where to go.

Your surgery will be one of the following locations:

The Presurgical Center (PSC) at Memorial Hospital
1275 York Ave. (between East 67^th and East 68^th streets)
New York, NY 10065
Take the B elevator to the 6^th floor.

Josie Robertson Surgery Center
1133 York Ave (between East 61^st and East 62^nd streets)
New York, NY 10065 

Visit www.msk.org/parking for parking information and directions to all MSK locations.

Shower with a 4% CHG solution skin cleanser (such as Hibiclens), if needed

If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, shower using a 4% CHG solution antiseptic skin cleanser.

Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

If you’re not having a sentinel lymph node biopsy or a groin lymph node dissection, you can shower as usual.

Instructions for eating

‌ 
Stop eating at midnight (12 a.m.) the night before your surgery. This includes hard candy and gum.

If your healthcare provider told you to stop eating earlier than midnight, follow their instructions. Some people need to fast (not eat) for longer before their surgery.

The morning of your vulvar surgery

Remember, do not eat anything after midnight (12 a.m.) the night before your surgery.

Instructions for drinking

Between midnight (12 a.m.) and 2 hours before your arrival time, only drink the liquids on the list below. Do not eat or drink anything else. Stop drinking 2 hours before your arrival time.

• Water.
• Clear apple juice, clear grape juice, or clear cranberry juice.
• Gatorade or Powerade.
• Black coffee or plain tea. It’s OK to add sugar. Do not add anything else.
  • Do not add any amount of any type of milk or creamer. This includes plant-based milks and creamers.
  • Do not add honey.
  • Do not add flavored syrup.

If you have diabetes, pay attention to the amount of sugar in these drinks. It will be easier to control your blood sugar levels if you include sugar-free, low-sugar, or no added sugar versions of these drinks.

It’s helpful to stay hydrated before surgery, so drink if you are thirsty. Do not drink more than you need. You will get intravenous (IV) fluids during your surgery.

‌ 
Stop drinking 2 hours before your arrival time. This includes water.

Take your medicines as instructed

A member of your care team will tell you which medicines to take the morning of your surgery. Take only those medicines with a sip of water. Depending on what you usually take, this may be all, some, or none of your usual morning medicines.

Shower with a 4% CHG solution antiseptic skin cleanser, such as Hibiclens

If you’re having a sentinel lymph node biopsy or a groin lymph node dissection, shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

If you’re not having a sentinel lymph node biopsy or a groin lymph node dissection, you can shower as usual. Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

Things to remember

• Wear something comfortable and loose-fitting.
• If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
• Do not wear any metal objects. Take off all jewelry, including body piercings. The tools used during your surgery can cause burns if they touch metal.
• Leave valuable items at home.
• If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. We’ll give you disposable underwear and a pad if you need them.

What to bring

• Your breathing device for sleep apnea (such as your CPAP machine), if you have one.
• Your Health Care Proxy form and other advance directives, if you filled them out.
• Your cell phone and charger.
• Only the money you may want for small purchases, such as a newspaper.
• A case for your personal items, if you have any. Eyeglasses, hearing aids, dentures, prosthetic devices, wigs, and religious articles are examples of personal items.
• This guide. You’ll use it to learn how to care for yourself after surgery.

Once you’re in the hospital

Many staff members will ask you to say and spell your name and birth date. This is for your safety. People with the same or a similar name may be having surgery on the same day.

We’ll give you a hospital gown, robe, and nonskid socks to wear when it’s time to change for surgery.

Meet with a nurse

You’ll meet with a nurse before surgery. Tell them the dose of any medicines you took after midnight (12 a.m.) and the time you took them. Make sure to include prescription and over-the-counter medicines, patches, and creams.

Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse does not place the IV, your anesthesiologist (A-nes-THEE-zee-AH-loh-jist) will do it in the operating room.

Meet with an anesthesiologist

You’ll also meet with an anesthesiologist before surgery. They will:

• Review your medical history with you.
• Ask if you’ve had any problems with anesthesia in the past. This includes nausea (feeling like you’re going to throw up) or pain.
• Talk with you about your comfort and safety during your surgery.
• Talk with you about the kind of anesthesia you’ll get.
• Answer questions you have about anesthesia.

Get ready for surgery

When it’s time for your surgery, you’ll take off your eyeglasses, hearing aids, dentures, prosthetic devices, wig, and religious articles.

You’ll either walk into the operating room or a staff member will bring you there on a stretcher. A member of the operating room team will help you onto the operating bed. They’ll put compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.

Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.

During your surgery

After you’re fully asleep, your care team will place a breathing tube through your mouth into your airway. It will help you breathe. They’ll also place a urinary (Foley) catheter in your bladder. It will drain your urine (pee) during your surgery.

During your surgery, your surgeon will make 1 or more incisions (surgical cuts) in your vulvar area. Your surgeon will then remove the tumor and all or part of your vulva. They may also remove some of the lymph nodes in your groin.

If you’re having reconstruction as part of your surgery, your surgeon may work with a plastic surgeon for that part of your surgery.

You will get an injection (shot) of long-acting lidocaine to help manage your pain.

Your care team will close your vulvar incisions with a mesh dressing, or sutures (stitches) that may loosen over time. A small amount of reddish drainage is normal. They will close the incisions in your groin with a mesh dressing, staples, or sutures.

Your care team will usually take out your breathing tube while you’re still in the operating room.

Recovering after your vulvar surgery

In the Post-Anesthesia Care Unit (PACU)

You’ll be in the PACU when you wake up after your surgery. A nurse will be keeping track of your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask over your nose and mouth. You’ll also have compression boots on your lower legs.

Because of your surgery, sitting may be uncomfortable or could harm your incisions. Do not sit until your nurse tells you that you can. Once you know it’s OK to sit, be sure to use a soft pillow or donut (soft inflatable plastic ring) to protect your incisions.

Pain medicine

You’ll have pain or discomfort at your incision sites. Your healthcare provider will ask you about your pain often and give you medicine as needed. If your pain is not relieved, tell your healthcare provider. It’s important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and get out of bed and walk.

Tubes and drains

You’ll have tubes, drains, and bandages on and around your vulvar area. They may include:

• A catheter or drainage tube to drain urine from your bladder.
• A Jackson-Pratt drain, if any of your lymph nodes were removed. This will help drain the fluid from your groin area and control lymphedema (swelling).

You may also have:

• An IV line to give you fluids.
• A pain pump called a patient-controlled analgesia (PCA) device. If you have a PCA device, read the resource Patient-Controlled Analgesia (PCA) for more information. You can find it online at www.mskcc.org/pe/pca, or ask for a printed copy.
• Compression boots on your calves to help blood circulate. These will stay on whenever you’re in bed until you’re discharged.

The staples will remain in place until you see your surgeon about 2 to 4 weeks after surgery.

Moving to your hospital room

You may stay in the PACU for a few hours or overnight. How long you stay depends on the type of surgery you had. A staff member will bring you to your hospital room after your stay in the PACU.

In your hospital room

The length of time you’re in the hospital after your surgery depends on your recovery. Most people stay in the hospital for 1 to 3 days.

In your hospital room, you’ll meet one of the nurses who will care for you during your stay. A nurse will help you out of bed and into your chair soon after you get there.

Your healthcare providers will teach you how to care for yourself while you’re healing from your surgery. Your nurse will also teach you how to care for your incisions at home. They’ll give you a peri-bottle and show you how to use it. This is a small plastic bottle with a squirt tip. It’s used to clean your vulvar incisions around your vulva and perineum.

You’ll get a prescription for pain medicine to take when you go home. Talk with your healthcare provider about possible side effects. Ask them when to start switching to over-the-counter pain medicine.

Managing your pain

We will ask you about your pain often and give you medicine as needed. Tell one of your healthcare providers if your pain is not relieved. It’s important to control your pain so you can use your incentive spirometer and move around. Controlling your pain can help you recover faster.

Moving around and walking

Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.

To learn more about how walking can help you recover, read Frequently Asked Questions About Walking After Your Surgery.

To learn what you can do to stay safe and keep from falling while you’re in the hospital, read Call! Don't Fall!.

Exercising your lungs

It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.

• Use your incentive spirometer 10 times every hour you’re awake. Read How To Use Your Incentive Spirometer to learn more.
• Do coughing and deep breathing exercises. A member of your care team will teach you how.

Eating and drinking

You can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery. Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.

It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.

For more tips on eating and drinking after your surgery, read Eating Well During Your Cancer Treatment. If you have questions about your diet, ask to see a clinical dietitian nutritionist.

Caring for your tubes and drains

Your vulvar incision(s) will be closed with sutures that may loosen over time. A small amount of reddish drainage is normal. The incision(s) in your groin will be closed with staples or sutures. These will remain in place until you see your surgeon about 2 to 4 weeks after surgery.

You may go home with the drains still in place as well. If so, your nurse will teach you how to care for them before you leave the hospital.

Be sure to look at your incisions with your nurse before you leave the hospital. This will let you know what they look like so you can notice any changes.

Your nurse will also teach you how to care for your incisions at home using your peri-bottle.

Showering

Talk with your care team about when it is safe to shower. Do not submerge your catheter in water, such as in a bathtub, swimming pool, or ocean.

Planning for discharge

A visiting nurse can come help youat home, if needed. They will help care for your drain, change your dressing, and manage pain medicine. Ask your healthcare provider for more information about how to arrange for a visiting nurse before you leave the hospital.

Leaving the hospital

Before you leave, look at your incisions with one of your healthcare providers. Knowing what it looks like will help you notice any changes later.

On the day of your discharge, plan to leave the hospital around 11 a.m. Your healthcare provider will write your discharge order and prescriptions before you leave. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.

If your ride is not here when you’re ready to leave, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information.

At home

Read What You Can Do to Avoid Falling to learn what you can do to keep from falling at home and during your appointments at MSK.

You’ll need time to heal and recover. Some people need longer to heal than others. Ask your healthcare provider what you should expect. They can tell you more, based on the surgery you had and how much tissue was removed.

For the first 3 to 4 weeks, you’ll only be able sit with the help of a soft pillow or donut. You can buy a donut from a local surgical supply store, or you can order one online.

You’ll be able to lie down or stand. If you had major surgery or reconstructive surgery, you may not be able to sit for up to 8 weeks. Your nurse will work with you to design a care plan that focuses on finding positions that are most comfortable for you.

Filling out your Recovery Tracker

We want to know how you’re feeling after you leave the hospital. To help us care for you, we’ll send questions to your MyMSK account. We’ll send them every day for 10 days after you’re discharged. These questions are known as your Recovery Tracker.

Fill out your Recovery Tracker every day before midnight (12 a.m.). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.

Based on your answers, we may reach out to you for more information. Sometimes, we may ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions.

To learn more, read Common Questions About MSK's Recovery Tracker.

Managing your pain

The amount of pain or discomfort can vary. You may still have some pain when you go home and will probably take pain medicine. Some people have soreness, tightness, or muscle aches around their incisions for 6 months or longer. This does not mean something is wrong.

Follow these guidelines to help manage your pain at home.

• Take your medicines as directed and as needed.
• Call your healthcare provider if the medicine prescribed for you does not help your pain.
• Do not drive or drink alcohol while you’re taking prescription pain medicine. Some prescription pain medicines can make you drowsy (very sleepy). Alcohol can make the drowsiness worse.
• You’ll have less pain and need less pain medicine as your incision heals. An over-the-counter pain reliever will help with aches and discomfort. Acetaminophen (Tylenol®) and ibuprofen (Advil or Motrin) are examples of over-the-counter pain relievers.
  • Follow your healthcare provider’s instructions for stopping your prescription pain medicine.
  • Do not take too much of any medicine. Follow the instructions on the label or from your healthcare provider.
  • Read the labels on all the medicines you’re taking. This is very important if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medicines. Taking too much can harm your liver. Do not take more than one medicine that has acetaminophen without talking with a member of your care team.
• Pain medicine should help you get back to your usual activities. Take enough to do your activities and exercises comfortably. You may have a little more pain as you start to be more active.
• Keep track of when you take your pain medicine. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.

Some prescription pain medicine, such as opioids, may cause constipation. Constipation is when you poop less often than usual, have a harder time pooping, or both.

Preventing and managing constipation

Talk with your healthcare provider about how to prevent and manage constipation. You can also follow these guidelines.

• Go to the bathroom at the same time every day. Your body will get used to going at that time. But if you feel like you need to go, don’t put it off.
• Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
• Exercise, if you can. Walking is a great type of exercise that can help prevent and manage constipation.
• Drink 8 to 10 (8-ounce) cups (2 liters) of liquids daily, if you can. Choose water, juices (such as prune juice), soups, and milkshakes. Limit liquids with caffeine, such as coffee and soda. Caffeine can pull fluid out of your body.
• Slowly raise the fiber in your diet to 25 to 35 grams a day. Unpeeled fruits and vegetables, whole grains, and cereals have fiber. If you have an ostomy or recently had bowel surgery, ask your healthcare provider before changing your diet.
• Both over-the-counter and prescription medicine can treat constipation. Ask your healthcare provider before taking any medicine for constipation. This is very important if you have an ostomy or have had bowel surgery. Follow the instructions on the label or from your healthcare provider. Examples of over-the-counter medicines for constipation are:
  • Docusate sodium (Colace®). This is a stool softener (medicine that makes your bowel movements softer) that causes few side effects. You can use it to help prevent constipation. Do not take it with mineral oil.
  • Polyethylene glycol (MiraLAX®). This is a laxative (medicine that causes bowel movements) that causes few side effects. Take it with 8 ounces (1 cup) of a liquid. Only take it if you’re already constipated.
  • Senna (Senokot®). This is a stimulant laxative, which can cause cramping. It’s best to take it at bedtime. Only take it if you’re already constipated.If any of these medicines cause diarrhea (loose, watery bowel movements), stop taking them. You can start again if you need to.

Caring for your incisions

Wound healing after vulvar surgery can be challenging, depending on the location of the incisions. Moisture and rubbing happens with daily activities, which affects vulvar wound healing. Urinating can be painful.

To keep your incisions clean:

• Use your peri-bottle to wash your vulvar and anal areas with warm water. Do this after every time you urinate or have a bowel movement.
• Use a sitz bath or hand spray shower at least 2 times every day.
• Shower every day, using soap and water.

To dry your incisions, pat them dry with a clean towel or use the “cool” setting on a hair dryer. Do not rub your incisions.

Here are some tips to make you more comfortable while your incision(s) are healing:

• Apply ice packs to the affected area as directed.
• Wear loose fitting clothing. Wear underwear that’s a size larger or men’s boxer shorts.
• Keep the area open to air at night.

You’ll see your surgeon about 2 to 4 weeks after surgery. They will check your incisions and remove any staples, sutures, or drains.

Showering

Take a shower every day to clean your incisions. If you have staples or stitches in your incisions, it’s OK to get them wet.

If you have a mesh dressing over your surgical site, leave it on when you shower. If you have white cloth dressings, take them off before you shower.

Use soap during your shower, but do not put it directly on your incision. Do not rub the area around your incision.

After you shower, pat the area dry with a clean towel. If your clothing may rub your incision, cover it with a small bandage. Otherwise, leave it uncovered.

Do not take a bath for the first 4 weeks after your surgery.

Eating and drinking

You can eat all the foods you did before your surgery, unless your healthcare provider gives you other instructions. Eating a balanced diet with lots of calories and protein will help you heal after surgery.

Try to eat a good protein source (such as meat, fish, or eggs) at each meal. You should also try to eat fruits, vegetables, and whole grains.

It’s also important to drink plenty of liquids. Choose liquids without alcohol or caffeine. Try to drink 8 to 10 (8-ounce) glasses of liquids every day.

For more tips on eating and drinking after your surgery, read Eating Well During Your Cancer Treatment. If you have questions about your diet, ask to see a clinical dietitian nutritionist.

About Lymphedema

Lymphedema is swelling that usually happens in the arms, legs, or both. It’s usually caused by lymph nodes being removed. If you had a groin lymph node dissection, you may have lymphedema in the leg on the side where the nodes were removed.

There are many things you can do to help prevent and manage lymphedema. For more information, read Reducing Your Risk of Lymphedema of the Legs.

You can also watch About Lymphedema of the Legs and Treatment for Lymphedema of the Legs.

Physical activity and exercise

Your incisions may look like they’re healed on the outside when you leave the hospital. They will not be healed on the inside. Before your post-op visit:

• Do not lift anything heavier than 10 pounds (4.5 kilograms).
• Do not do any high-energy activities, such as jogging and tennis.
• Do not play any contact sports, such as football.

Talk with your healthcare provider during your post-op visit about when it is safe to do these activities again.

Doing physical activity, such as walking and stair climbing, will help you gain strength and feel better. Try to 20 to 30 minutes of physical activity at least 2 to 3 times a day. For example, you can walk outside or indoors at your local mall or shopping center.

It’s common to have less energy than usual after surgery. Recovery time is not the same for everyone. Do more activity each day as much as you can. Always balance activity periods with rest periods. Rest is an important part of your recovery.

Driving

Ask your healthcare provider when you can drive. Most people can start driving again about 1 week after surgery. Do not drive while you’re taking pain medicine that can make you drowsy.

You can ride in a car as a passenger at any time after you leave the hospital.

Going back to work

Talk with your healthcare provider about your job. They’ll tell you when it may be safe for you to start working again based on what you do. If you move around a lot or lift heavy objects, you may need to stay out a little longer. If you sit at a desk, you may be able to go back sooner.

Traveling

Avoid traveling until after your post-op visit. Talk with your healthcare provider during your post-op visit about when it is safe to travel.

Managing your feelings

You may have new and upsetting feelings after a surgery for a bad illness. Many people say they felt weepy, sad, worried, nervous, irritable, or angry now and then.

You may find it’s hard to control some of these feelings. If this happens, it’s a good idea to get emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.

The first step in coping is to talk about how you feel. Family and friends can help.

It’s always a good idea to let us know how you, your family, and your friends are feeling emotionally. We can also reassure, support, and guide you. We have many resources available to you and your family to help handle the emotional aspects of your illness. We can help whether you’re in the hospital, or at home.

Emotional support

This surgery will change your body. It will probably take time for you to adjust to these changes. You may have questions or fears about how this surgery will affect your sexuality and sexual activities. These feelings are normal, and most people have them.

Some people take a few months to adjust to a changed body image, while others take longer. As time goes on, you’ll get stronger emotionally and physically. You’ll get more comfortable with your appearance. Your appetite and energy will improve. Soon, you’ll be able to do most of your normal activities.

We have many resources to help you. Your healthcare providers can answer your questions. But we also have social workers, psychologists, and psychiatrists experienced in helping people through this change. You can have one-on-one counseling, or you can join one of our online or in-person support groups. We also have clergy available for spiritual support.

You may be able to meet with another person who has had this surgery. They can talk with you and answer your questions. Talk with your nurse if you’re interested in doing this.

Your sexuality after surgery

Talk with your healthcare provider about when it’s safe for you to start sexual activities. This is usually after your incisions fully heal.

Most people who have a partial or a simple vulvectomy can do sexual activities after their incisions have healed.

You may have vaginal tightness if you had:

• A complete radical vulvectomy.
• Radiation therapy before your surgery.
• A lot of reconstruction around your vaginal opening.

This can make it hard to have intercourse, but using lubrication can help.

For help with sexual health and intimacy issues, ask to see someone from our Female Sexual Medicine & Women’s Health Program. For more information or to make an appointment, call 646-888-5076.

When to call your healthcare provider

Call your healthcare provider if:

• You have a fever of 100.5 °F (38 °C) or higher.
• You have chills.
• The area around your incision is starting to swell.
• Swelling around your incision is getting worse.
• You have increased discomfort in the area of your incisions.
• You have drainage or a foul odor (bad smell) from your incisions.
• You have bleeding from your incisions.
• You have trouble urinating (peeing).
• You have any problems you didn’t expect.
• You have any questions or concerns.

Contact information

Monday through Friday from 9 a.m. to 5 p.m., call your healthcare provider’s office.

After 5 p.m., during the weekend, and on holidays, call 212-639-2000. Ask to talk with the person on call for your healthcare provider.

Support services

This section has a list of support services. They may help you as you get ready for your surgery and recover after your surgery.

MSK support services

Admitting Office
212-639-7606
Call if you have questions about your hospital admission, such as asking for a private room.

Anesthesia
212-639-6840
Call if you have questions about anesthesia.

Blood Donor Room
212-639-7643
Call for information if you’re interested in donating blood or platelets.

Bobst International Center
332-699-7968
We welcome patients from around the world and offer many services to help. If you’re an international patient, call for help arranging your care.

Counseling Center
www.msk.org/counseling
646-888-0200
Many people find that counseling helps them. Our Counseling Center offers counseling for individuals, couples, families, and groups. We can also prescribe medicine to help if you feel anxious or depressed. Ask a member of your care team for a referral or call the number above to make an appointment.

Food Pantry Program
646-888-8055
We give food to people in need during their cancer treatment. Talk with a member of your care team or call the number above to learn more.

Integrative Medicine Service
www.msk.org/integrativemedicine
Our Integrative Medicine Service offers many services to complement (go along with) traditional medical care. For example, we offer music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy. Call 646-449-1010 to make an appointment for these services.

You can also schedule a consultation with a healthcare provider in the Integrative Medicine Service. They’ll work with you to make a plan for creating a healthy lifestyle and managing side effects. Call 646-608-8550 to make an appointment for a consultation.

MSK Library
library.mskcc.org
212-639-7439
You can visit our library website or call to talk with the library reference staff. They can help you find more information about a type of cancer. You can also visit the library’s Patient and Health Care Consumer Education Guide.

Nutrition Services
www.msk.org/nutrition
212-639-7312
Our Nutrition Service offers nutritional counseling with one of our clinical dietitian nutritionists. Your clinical dietitian nutritionist will talk with you about your eating habits. They can also give advice on what to eat during and after treatment. Ask a member of your care team for a referral or call the number above to make an appointment.

Patient and Community Education
www.msk.org/pe
Visit our patient and community education website to search for educational resources, videos, and online programs.

Patient Billing
646-227-3378
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.

Patient Representative Office
212-639-7202
Call if you have questions about the Health Care Proxy form or concerns about your care.

Perioperative Nurse Liaison
212-639-5935
Call if you have questions about MSK releasing any information while you’re having surgery.

Private Duty Nurses and Companions
917-862-6373
You can request private nurses or companions to care for you in the hospital and at home. Call to learn more.

Rehabilitation Services
www.msk.org/rehabilitation
Cancers and cancer treatments can make your body feel weak, stiff, or tight. Some can cause lymphedema (swelling). Our physiatrists (rehabilitation medicine doctors), occupational therapists (OTs), and physical therapists (PTs) can help you get back to your usual activities.

• Rehabilitation medicine doctors diagnose and treat problems that affect how you move and do activities. They can design and help coordinate your rehabilitation therapy program, either at MSK or somewhere closer to home. Call Rehabilitation Medicine (Physiatry) at 646-888-1929 to learn more.
• An OT can help if you’re having trouble doing usual daily activities. For example, they can recommend tools to help make daily tasks easier. A PT can teach you exercises to help build strength and flexibility. Call Rehabilitation Therapy at 646-888-1900 to learn more.

Resources for Life After Cancer (RLAC) Program
646-888-8106
At MSK, care does not end after your treatment. The RLAC Program is for patients and their families who have finished treatment.

This program has many services. We offer seminars, workshops, support groups, and counseling on life after treatment. We can also help with insurance and employment issues.

Sexual Health Programs
Cancer and cancer treatments can affect your sexual health, fertility, or both. MSK’s sexual health programs can help you before, during, or after your treatment.

• Our Female Sexual Medicine and Women’s Health Program can help with sexual health problems such as premature menopause or fertility issues. Ask a member of your MSK care team for a referral or call 646-888-5076 to learn more.
• Our Male Sexual and Reproductive Medicine Program can help with sexual health problems such as erectile dysfunction (ED). Ask a member of your care team for a referral or call 646-888-6024 to learn more.

Social Work
www.msk.org/socialwork
212-639-7020
Social workers help patients, families, and friends deal with common issues for people who have cancer. They provide individual counseling and support groups throughout your treatment. They can help you communicate with children and other family members.

Our social workers can also help refer you to community agencies and programs. If you’re having trouble paying your bills, they also have information about financial resources. Call the number above to learn more.

Spiritual Care
212-639-5982
Our chaplains (spiritual counselors) are available to listen, help support family members, and pray. They can contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can ask for spiritual support. You do not have to have a religious affiliation (connection to a religion).

MSK’s interfaith chapel is located near Memorial Hospital’s main lobby. It’s open 24 hours a day. If you have an emergency, call 212-639-2000. Ask for the chaplain on call.

Tobacco Treatment Program
www.msk.org/tobacco
212-610-0507
If you want to quit smoking, MSK has specialists who can help. Call to learn more.

Virtual Programs
www.msk.org/vp
We offer online education and support for patients and caregivers. These are live sessions where you can talk or just listen. You can learn about your diagnosis, what to expect during treatment, and how to prepare for your cancer care.

Sessions are private, free, and led by experts. Visit our website to learn more about Virtual Programs or to register.

External support services

Access-A-Ride
web.mta.info/nyct/paratran/guide.htm
877-337-2017
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.

Air Charity Network
www.aircharitynetwork.org
877-621-7177
Provides travel to treatment centers.

American Cancer Society (ACS)
www.cancer.org
800-ACS-2345 (800-227-2345)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.

Cancer and Careers
www.cancerandcareers.org
646-929-8032
A resource for education, tools, and events for employees with cancer.

CancerCare
www.cancercare.org
800-813-4673
275 Seventh Avenue (Between West 25^th & 26^th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.

Cancer Support Community
www.cancersupportcommunity.org
Provides support and education to people affected by cancer.

Caregiver Action Network
www.caregiveraction.org
800-896-3650
Provides education and support for people who care for loved ones with a chronic illness or disability.

Corporate Angel Network
www.corpangelnetwork.org
866-328-1313
Offers free travel to treatment across the country using empty seats on corporate jets.

Good Days
www.mygooddays.org
877-968-7233
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medicine that’s part of the Good Days formulary.

HealthWell Foundation
www.healthwellfoundation.org
800-675-8416
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medicines and therapies.

Joe’s House
www.joeshouse.org
877-563-7468
Provides a list of places to stay near treatment centers for people with cancer and their families.

LGBT Cancer Project
www.lgbtcancer.com
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.

LIVESTRONG Fertility
www.livestrong.org/we-can-help/fertility-services
855-744-7777
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.

Look Good Feel Better Program
www.lookgoodfeelbetter.org
800-395-LOOK (800-395-5665)
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.

National Cancer Institute
www.cancer.gov
800-4-CANCER (800-422-6237)

National LGBT Cancer Network
www.cancer-network.org
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.

Needy Meds
www.needymeds.org
Lists Patient Assistance Programs for brand and generic name medicines.

NYRx
www.health.ny.gov/health_care/medicaid/program/pharmacy.htm
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.

Patient Access Network (PAN) Foundation
www.panfoundation.org
866-316-7263
Gives help with copayments for patients with insurance.

Patient Advocate Foundation
www.patientadvocate.org
800-532-5274
Provides access to care, financial assistance, insurance assistance, job retention assistance, and access to the national underinsured resource directory.

Professional Prescription Advice
www.pparx.org
888-477-2669
Helps qualifying patients without prescription drug coverage get free or low-cost medicines.

Red Door Community (formerly known as Gilda’s Club)
www.reddoorcommunity.org
212-647-9700
A place where people living with cancer find social and emotional support through networking, workshops, lectures, and social activities.

RxHope
www.rxhope.com
877-267-0517
Provides assistance to help people get medicines they have trouble affording.

Triage Cancer
www.triagecancer.org
Provides legal, medical, and financial information and resources for cancer patients and their caregivers.

Educational resources

This section lists the educational resources mentioned in this guide. They will help you get ready for your surgery and recover after your surgery.

As you read these resources, write down questions to ask your healthcare provider.

• A Guide for Caregivers
• About Lymphedema of the Legs
• Common Questions About MSK's Recovery Tracker
• Advance Care Planning for People With Cancer and Their Loved Ones
• Call! Don't Fall!
• Frequently Asked Questions About Walking After Your Surgery
• Herbal Remedies and Cancer Treatment
• How to Be a Health Care Agent
• How To Check if a Medicine or Supplement Has Aspirin, Other NSAIDs, Vitamin E, or Fish Oil
• How to Enroll in MyMSK: Memorial Sloan Kettering's Patient Portal
• How To Use Your Incentive Spirometer
• Information for Family and Friends for the Day of Surgery
• Patient-Controlled Analgesia (PCA)
• Reducing Your Risk of Lymphedema of the Legs
• Treatment for Lymphedema of the Legs
• What You Can Do to Avoid Falling