Vulvectomy

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Vulvectomy
Diagram of a 3 in 1 incision vulvectomy CRUK 018.svg
A 3 in 1 incision vulvectomy
ICD-9-CM 71.5-71.6

Vulvectomy refers to a gynecological procedure in which the vulva is partly or completely removed. The procedure is usually performed as a last resort in certain cases of cancer, [1] vulvar dysplasia, vulvar intraepithelial neoplasia, [2] or as part of female genital mutilation. Although there may be severe pain in the groin area after the procedure, for a number of weeks, sexual function is generally still possible but limited. [3]

Contents

Types

A simple vulvectomy can be either complete (more than 80% of the vulvar area) or partial (less than 80% of vulvar area). It removes the skin and superficial subcutaneous tissues. A radical vulvectomy is the same with regard to complete or partial, however, includes removal of skin and deep subcutaneous tissue. An inguinofemoral lymphadenectomy may be performed along with a radical vulvectomy (whether partial or complete) on one or both sides if spread of a cancer is suspected. [4]

A partial vulvectomy of the top area of the vulva Diagram of a partial or simple vulvectomy affecting the top area of the vulva CRUK 025.svg
A partial vulvectomy of the top area of the vulva
A partial vulvectomy of one side of the vulva Diagram of a partial or simple vulvectomy on one side of the vulva CRUK 026.svg
A partial vulvectomy of one side of the vulva
A partial vulvectomy of the bottom area of the vulva Diagram showing a simple or partial vulvectomy when the cancer is affecting the bottom part of the vulva and perineal area CRUK 079.svg
A partial vulvectomy of the bottom area of the vulva

A simple partial vulvectomy is the least severe, only removing the affected portion of the vulva.

A "skinning vulvectomy" is the removal of the top layer of vulvar skin (the external female genital organs, including the clitoris, vaginal lips and the opening of the vagina). In this case skin grafts from other parts of the body may be needed to cover the area. There are two types of skinning vulvectomy, the "partial" and the "total". The objective of the first is the preservation of the cosmetic and functional integrity of the vulva in younger and sexually active patients, in whom a steady increase in the incidence of vulvar intraepithelial neoplasia has been observed in the last decade.[ when? ] The objective of the latter is the removal of the entire vulva with total skin graft replacement in patients with an entire vulvar cancer involvement. "Modified radical vulvectomy" involves the removal of vulva containing cancer and some of the normal tissue around it.

See also

Related Research Articles

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<span class="mw-page-title-main">Colposcopy</span> Medical examination of the cervix

Colposcopy is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope.

<span class="mw-page-title-main">Anal cancer</span> Medical condition

Anal cancer is a cancer which arises from the anus, the distal opening of the gastrointestinal tract. Symptoms may include bleeding from the anus or a lump near the anus. Other symptoms may include pain, itchiness, or discharge from the anus. A change in bowel movements may also occur.

<span class="mw-page-title-main">Lichen sclerosus</span> Itchy skin rash usually affecting the genitals

Lichen sclerosus (LS) is a chronic, inflammatory skin disease of unknown cause which can affect any body part of any person but has a strong preference for the genitals and is also known as balanitis xerotica obliterans (BXO) when it affects the penis. Lichen sclerosus is not contagious. There is a well-documented increase of skin cancer risk in LS, potentially improvable with treatment. LS in adult age women is normally incurable, but improvable with treatment, and often gets progressively worse if not treated properly. Most males with mild or intermediate disease restricted to foreskin or glans can be cured by either medical or surgical treatment.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

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<span class="mw-page-title-main">Labiaplasty</span> Plastic surgery procedure for altering the labia minora

Labiaplasty is a plastic surgery procedure for creating or altering the labia minora and the labia majora, the folds of skin of the human vulva. It is a type of vulvoplasty. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their vulvas because they believe they do not fall within a normal range.

<span class="mw-page-title-main">Cervical intraepithelial neoplasia</span> Medical condition

Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. More specifically, CIN refers to the potentially precancerous transformation of cells of the cervix.

<span class="mw-page-title-main">Vaginectomy</span> Surgical removal of the vagina

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<span class="mw-page-title-main">Vulvar cancer</span> Cancer involving the vulva

Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or Bartholin's glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.

<span class="mw-page-title-main">Vulvar intraepithelial neoplasia</span> Medical condition

Vulvar intraepithelial neoplasia (VIN) refers to particular changes that can occur in the skin that covers the vulva. VIN is an intraepithelial neoplasia, and can disappear without treatment. VINs are benign but if the changes become more severe, there is a chance of cancer developing after many years, and so it is referred to as a precancerous condition.

<span class="mw-page-title-main">Clitoral hood reduction</span> Cosmetic surgical procedure

Clitoral hood reduction, also termed clitoral hoodectomy, clitoral unhooding, clitoridotomy, or (partial) hoodectomy, is a plastic surgery procedure for reducing the size and the area of the clitoral hood in order to further expose the glans of the clitoris.

<span class="mw-page-title-main">Perineoplasty</span>

Perineoplasty denotes the plastic surgery procedures used to correct clinical conditions of the vagina and the anus. Among the vagino-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, fecal incontinence, genital warts, dyspareunia, vaginal stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vagino-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles.

<span class="mw-page-title-main">Vulva</span> External genitalia of the female mammal

In mammals, the vulva consists of the external female genitalia. The human vulva includes the mons pubis, labia majora, labia minora, clitoris, vulval vestibule, urinary meatus, the vaginal opening, hymen, and Bartholin's and Skene's vestibular glands. The urinary meatus is also included as it opens into the vulval vestibule. The vulva includes the entrance to the vagina, which leads to the uterus, and provides a double layer of protection for this by the folds of the outer and inner labia. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.

A vulvar disease is a particular abnormal, pathological condition that affects part or all of the vulva. Several pathologies are defined. Some can be prevented by vulvovaginal health maintenance.

Lymphatogenous metastasis is the spread of cancer from the vulva, clitoris and Bartholin glands. As these other more superficial cancers grow deeper into the surrounding tissue, the risk of lymphatogenous metastasis increases. Vulvar cancers spread primarily to the inguinofemoral lymph nodes. From these lymph nodes, cancer can spread to the pelvic lymph nodes.

<span class="mw-page-title-main">Bartholin gland carcinoma</span> Medical condition

Bartholin gland carcinoma is a type of cancer of the vulva arising in the Bartholin gland. It typically presents with a painless mass at one side of the vaginal opening in a female of middle-age and older, and can appear similar to a Bartholin cyst. The mass may be big or small, may be deep under skin or appear nearer the surface with overlying ulceration. Average age at presentation is 53-years.

A vestibulectomy is a gynecological surgical procedure that can be used to treat vulvar pain, specifically in cases of provoked vestibulodynia. Vestibulodynia is a chronic pain syndrome that is a subtype of localized vulvodynia where chronic pain and irritation is present in the vulval vestibule, which is near the entrance of the vagina. Vestibulectomy may be partial or complete.

Crohn's disease (CD) of the vulva is a rare extra intestinal condition, with granulomatous cutaneous lesions affecting the female genitalia. Lesions connected to the affected gut via a healthy tissue are referred to as metastatic lesions.

Vulvar tumors are those neoplasms of the vulva. Vulvar and vaginal neoplasms make up a small percentage (3%) of female genital cancers. They can be benign or malignant. Vulvar neoplasms are divided into cystic or solid lesions and other mixed types. Vulvar cancers are those malignant neoplasms that originate from vulvar epithelium, while vulvar sarcomas develop from non-epithelial cells such as bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Epithelial and mesenchymal tissue are the origin of vulvar tumors.

References

  1. Fuh KC and Berek JS (2012) Current management of vulvar cancer. Hematol Oncol Clin North Am. 26(1):45-62. doi : 10.1016/j.hoc.2011.10.006
  2. Hillemans P, Wang X, Staehle S, Michels W, Dannecker C (2006) Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy. Gynecol Oncol. 100:271-5. doi : 10.1016/j.ygyno.2005.08.012
  3. Aerts L et al (2012) Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: a literature review. J. Sex. Med. 9(2):361-71. doi : 10.1111/j.1743-6109.2011.02520.x
  4. American Medical Association Current Procedural Terminology (CPT) Professional Edition 2015 ISBN   162202026X