Surgery Vulvectomy partial or total Dr Jérémie Zeitoun · Surgeon Paris 8th
The reference surgery for invasive vulvar cancers and some precancerous lesions (differentiated VIN, Paget disease). Indications, actual procedure, recovery, complications, what to expect — everything is explained clearly.
Vulvectomy, in 7 key figures
Concrete and meaningful information to prepare for this procedure. All these figures reflect current practice in French expert centres.
Vulvectomy remains the reference surgery for treating invasive vulvar cancer. The main goal is to achieve clear surgical margins on histology — that is the condition for good local control. The secondary goal is to preserve function and body image as much as possible. Depending on lesion size and location, the procedure is partial or total, sometimes combined with a reconstructive flap.
Partial, total, radical: which vulvectomy for which situation
The word "vulvectomy" actually covers several very different procedures. To keep things simple, vulvectomy is classified along three axes that combine: which part of the vulva is removed (extent), how deep the cut goes (superficial or deep), and whether the groin nodes are involved or not (simple or radical). The chosen type depends on lesion size, location, and stage. The decision is always made at the multidisciplinary team meeting before surgery.
1 — Which part is removed (extent)
Partial, total or wide vulvectomyPartial vulvectomy (or "simple"). We remove only the area around the lesion, with a safety margin of about 1 cm. The rest of the vulva is preserved. This is today the most frequent intervention for small cancers (T1) and well-localised precancerous lesions.
Total vulvectomy. We remove the entire vulva — labia majora, labia minora, sometimes clitoral hood — when the lesion is very extensive or multifocal (several foci at different sites).
Wide vulvectomy. We remove the lesion with a larger margin (often > 1 cm, sometimes up to 2 cm), in particular for vulvar melanomas or cancers with a high risk of local recurrence. The extent is greater than a classic partial vulvectomy but does not go as far as removing the entire vulva.
2 — How deep the cut goes
Superficial or deep vulvectomySuperficial vulvectomy (or "skinning"). We remove only the skin and the layer just underneath. The deeper tissue (fat, muscle) is preserved. Indication: precancerous lesions (extensive VIN, Paget disease without invasion), for which cancer has not penetrated deeply.
Deep vulvectomy. We remove the skin and the fat down to the aponeurosis (fibrous membrane covering the muscles). Indication: invasive cancers (squamous cell carcinoma, melanoma), to ensure that the entire depth of the lesion is removed with clear margins.
In summary: depth depends on the nature of the lesion. Precancer → superficial is enough. Invasive cancer → deep is essential.
3 — Whether we touch the groin nodes or not
Simple or radical vulvectomySimple vulvectomy. We do not touch the groin nodes. Indication: precancerous lesions, or very small cancers (T1a, invasion ≤ 1 mm) where the nodal risk is nil.
Radical vulvectomy. The vulvectomy is combined with a procedure on the groin nodes. Two options depending on the situation:
• Inguinal nodal exploration (targeted removal of 1 to 3 "sentinel" nodes) — the modern technique for cancers ≤ 4 cm without palpable node. It avoids the complications of full dissection. More on the sentinel node.
• Full inguinal lymphadenectomy (removal of all groin nodes) — for extensive cancers, palpable nodes, or in case of positive sentinel node.
How these 3 axes combine in practice
Concrete examples of combinationsExample 1 — Extensive VIN (precancerous lesion). Partial + superficial + simple vulvectomy. We remove only the precancerous area, in the skin layer, without touching the nodes. Light recovery.
Example 2 — T1b squamous cell carcinoma of 1.5 cm (early-stage cancer). Partial + deep + radical vulvectomy with sentinel node. We remove the lesion in depth, with targeted exploration of the groin.
Example 3 — Extensive vulvar Paget disease without invasion. Total + superficial + simple vulvectomy, often with reconstructive flap.
Example 4 — Vulvar melanoma. Wide + deep + radical vulvectomy with sentinel node, according to the Breslow index.
That is why every vulvectomy is different. The decision is always personalised and discussed at the multidisciplinary team meeting before surgery.
In what situations
Vulvectomy is offered for different types of vulvar lesions. Without going into the technical detail of medical stages — which would mean little to you and unnecessarily complicate things — here are the main situations in which we discuss it.
Abnormal cells have been found on the vulvar skin, without cancer yet established (VIN, vulvar Paget disease). We operate to remove these cells before they evolve. The surgery is often superficial and limited.
The cancer is localised to the vulva, of small size. We remove the lesion with a safety margin, and we examine the groin nodes (usually by sentinel node). The prognosis is very good.
The cancer is larger or affects several areas of the vulva. The surgery is wider, sometimes combined with full inguinal lymphadenectomy. Radiotherapy may be added depending on the case.
Some rarer lesions (melanoma of the vulva, basal cell carcinoma, other skin tumours) also require vulvectomy, with specificities for each type.
In all cases, surgery is personalised. The exact type of vulvectomy (partial, total, wide; superficial, deep; simple, radical — see section Types) depends on your specific situation: size, location, depth, nature of the lesion, state of the nodes.
The decision is always taken at the multidisciplinary team meeting — a panel of specialists (surgeon, oncologist, radiotherapist, pathologist, radiologist) reviews your case together before confirming the best strategy for you. Then I take the time to explain it to you at consultation.
Guidelines used (2025 update): FIGO 2025 (Olawaiye et al, Int J Gynecol Obstet 2025, global update) · NCCN Vulvar Cancer 2025 (v1.2025, US guidelines) · Restaino et al, Cancers 2025 (systematic comparison of international guidelines) · ESGO 2023 (Oonk MHM et al, Int J Gynecol Cancer 2023, European guidelines) · Saint-Paul-de-Vence 2024 (Selle & Narducci, Francophone guidelines) · GROINSS-V I (Van der Zee AGJ et al, J Clin Oncol 2008, n=403) and GROINSS-V II (Oonk MHM et al, Lancet Oncol 2021, n=1535) for the sentinel node.
Has a vulvectomy been recommended?
Bring your biopsy reports, pelvic MRI and MDT decision if available. The consultation lasts 30 minutes — a personalised plan is provided with the type of vulvectomy considered.
How a vulvectomy takes place, step by step
From arrival at the clinic to discharge home, here is exactly what awaits you. This transparency is a mark of respect: you have the right to know.
- 01
The day before — preparation
Hospital admission the day before or the same morning depending on the case. Antiseptic shower. Fasting from midnight (water allowed up to 2h before surgery). Limited shaving of the operative area. First interview with the paramedical team.
- 02
Arrival at theatre
Identity check, file, consent. Peripheral venous access. General anaesthesia — most often combined with epidural analgesia for postoperative comfort.
- 03
The surgery
Lithotomy position (legs in stirrups). Pen markings of excision limits according to planned margins. Excision of the specimen, careful haemostasis. Suction drains if needed. Suturing in successive layers. Urinary catheter placement.
- 04
Recovery room
Monitoring in recovery for 1 to 2 hours. Assessment of pain, wound. Return to room. Systematic analgesia. Early mobilisation from the next day to prevent thrombosis.
- 05
Hospital stay
3 to 5 days on average. Monitoring of wound, drains, urine output. Progressive removal of urinary catheter (D2-D5). Daily local care. Mobilisation. Preventive anticoagulation by subcutaneous injection.
- 06
Discharge home
Discharge with prescriptions for nursing care, analgesia, anticoagulation. Povidone-iodine sitz baths twice daily. Wound monitoring. D15 postoperative consultation for histopathology results and MDT decision.
Before any vulvectomy, you will be seen at surgical consultation, then at anaesthesia consultation. A psychological consultation may be offered, particularly if the procedure is extensive. Do not hesitate to ask any questions, request to meet another patient already operated, or take time to reflect. This surgery is never so urgent that it prevents thorough preparation.
Recovery, complications and return to normal life
Vulvar healing is a particular area: the skin is thin, the area is humid, subject to friction and urination. Complications are frequent — but most often benign and well managed with rigorous follow-up.
Most frequent complications
Vulvar healing is fragile — the skin is thin, the area is humid and subject to friction and urination. Wound complications are common, but they are never a surgical failure. All of them are managed at the consultation or by teleconsultation, with local care. Here are the real figures reported in the literature, with full transparency.
| Complication | Frequency |
|---|---|
| Wound dehiscence (partial or total) | up to 50 % |
| Wound infection | 8 – 15 % |
| Haematoma | 5 – 10 % |
| Transient urinary retention | 10 – 20 % |
| Leg lymphoedema (if inguinal dissection) | 20 – 40 % after dissection 1 – 5 % after sentinel node |
| Insufficient margins (revision surgery) | 5 – 15 % |
| Dyspareunia (painful intercourse) long-term | 15 – 30 % |
References: Senn B et al, Gynecol Oncol 2013 (50 % dehiscence rate) · Pouwer AW et al, Ann Surg Oncol 2019 · Hinten F et al, Gynecol Oncol 2011 (53 % wound complications) · Gaarenstroom KN et al, Int J Gynecol Cancer 2003 · GROINSS-V I & II.
A dehiscence at 50 % is not a failure: it is the natural consequence of the fragility of vulvar skin. Healing then quietly resumes through a so-called "directed" mechanism — daily local care and patience. You stay in direct contact with me throughout this period. A question, a doubt, a photo to send me: teleconsultation is made for this.
Recovery timeline
Recovery after vulvectomy is longer than one might imagine. Vulvar skin heals slowly, and the area is solicited with every urination and every movement. This time must be accepted to reach complete healing and a serene return to normal life.
Hospital stay. Urinary catheter. Daily local care. Analgesia. Progressive mobilisation.
Return home. Nurse 2x/day. Povidone sitz baths. Rest. Wound monitoring.
The most fragile phase. Dehiscence possible. Walking allowed, avoid prolonged sitting. D15 consultation.
Progressive healing. Return to sedentary work possible. No sport, no bath, no intercourse.
Complete healing in most patients. Light sport. Gradual return to intimate life (pelvic floor physio recommended).
Follow-up every 3-4 months. Suppleness and comfort regained. Long-term monitoring (5 years minimum).
25 questions about vulvectomy
All the questions patients ask most often in consultation. If yours is not here, ask it at our appointment — there is no stupid question.
How long does a vulvectomy take?
▾What type of anaesthesia is used?
▾How many days of hospitalisation should I expect?
▾Will I have a urinary catheter after surgery?
▾Will I have pain after surgery?
▾How long does complete healing take?
▾What is wound dehiscence?
▾Will I be able to walk after surgery?
▾When can I return to work?
▾Will I lose vulvar sensitivity?
▾Will vulvectomy change my sexual life?
▾Will I be menopausal after the vulvectomy?
▾What home care after discharge?
▾When will I have the histology results?
▾Will I need radiotherapy after?
▾And if surgical margins are insufficient?
▾What follow-up after vulvectomy?
▾Is vulvectomy 100% reimbursed?
▾Can I get a second opinion before surgery?
▾Will my surgeon stay in contact with me?
▾What to do in case of bleeding or fever?
▾Should the ovaries be removed during vulvectomy?
▾What is a reconstructive flap?
▾How many patients does Dr Zeitoun operate per year?
▾Will I have psychological support?
▾Also read
Book an appointment
Has a vulvectomy been recommended? Bring your biopsy reports, pelvic MRI and MDT decision if available. The consultation lasts 30 minutes — a personalised plan is provided.