Possible problems after vaginal cancer surgery

There is a risk of problems or complications after any operation, including surgery for vaginal cancer. Many problems are minor but some can be very serious. Treating them as soon as possible is important.

Your nurse will give you the phone numbers of who to contact if you have any problems when you are at home.

Infections

You are at risk of getting an infection after surgery, such as a wound or chest infection. Tell your doctor or nurse if you have any symptoms of infection.

They include:

• a high temperature
• shivering
• feeling hot and cold
• feeling generally unwell
• a cough
• feeling sick
• swelling or redness around your wound

Your doctor can give you antibiotics. Occasionally for an infection in your wound or pelvis, you may need another operation.

Blood clots

After surgery, you're at risk of blood clots developing in your pelvis or legs. This could lead to a blood clot in your lungs.

To prevent blood clots, your nurses get you up as soon as possible after your operation, and encourage you to move around or do your leg exercises.

Also, during and after your operation, you wear special stockings (called anti embolism stockings or TEDS). And after your operation you usually have injections to thin your blood. You may have the injections for up to 4 weeks after surgery.

Vaginal narrowing

Scar tissue can form following surgery to the vagina. Scar tissue is more fibrous than healthy tissue so it’s stiffer and less stretchy.

Scar tissue might form around the outside of the vagina and narrow the entrance. This might apply to people who have not had their vagina removed or have had part of their vagina removed. You might find that penetrative sex can be painful because of the narrowing.

Using dilators

To help prevent narrowing, your specialist nurse will teach you to stretch the vaginal opening with dilators. You might also need to use dilators if you have a vaginal reconstruction.

Dilators are smooth cone shaped objects that you put into your vagina to stretch it. They come in sets of different sizes. You usually start using them once the area has healed after surgery.

Your nurse will tell you how to use them and how often. For example, you may do this for a few minutes every day over a few weeks. Then reduce it to 3 to 4 times each week. You begin with a comfortable size dilator and then use larger ones until your vagina is stretched enough for you to have sex comfortably.

Contact your specialist nurse or doctor if you have any problems or questions. A surgeon can sometimes use skin grafts to widen the vaginal opening if dilators have not worked.

Difficulty having an orgasm

Removing the lower part of the vagina can cause a reduction in sexual desire. There may be less pleasure during sex and problems reaching orgasm.

This doesn’t always happen, it depends on the exact position and size of the cancer. You will need to discuss this with your surgeon. They will explain as much as possible before the operation, but they might not be able to say exactly how the surgery will affect your sensations during sex.

There are sex therapists you can see if you would like to. Talk to your GP or specialist nurse. They can put you in touch with a therapist.

Leg and groin swelling (lymphoedema)

Depending on the type of operation you have, you might need to have the lymph nodes removed in your groin. It is common to have some swelling around the genital area for a couple of weeks after surgery. If this continues or you notice some swelling in your legs or feet, you may be developing lymphoedema.

Lymphoedema is a build up of lymph fluid that causes swelling in a part of the body. It may affect one or both legs depending on the type of surgery you had. 

Tips to help reduce the risk of lymphoedema:

• Protect your legs and feet from sharp objects – always wear shoes, and wear long trousers for gardening.
• Wear insect repellent so that you don't get bitten.
• Take care of all cuts, scratches or bites straight away by cleaning them with antiseptic and covering with a dressing.
• Avoid sunburn.
• Take extra care when cutting your toenails – you should not cut or tear the cuticles.
• Be careful when removing body hair. Using hair removal cream can be better than shaving. But test the cream first on another part of your body.

If you notice any swelling, tell your doctor or specialist nurse straight away. Lymphoedema is easier to control if it is caught early. They can refer you to a lymphoedema specialist for assessment. The specialist is usually a nurse or physiotherapist.

Ways to manage lymphoedema

The lymphoedema specialist might try different treatments to manage your lymphoedema. These include:

• specially fitted support stockings
• compression bandaging
• a type of massage called manual lymphatic drainage (MLD)
• an inflatable sleeve that gently squeezes fluid towards the top of your legs to drain it away through the lymphatic vessels

These treatments should only be carried out by someone with specialist training in lymphoedema. 

Bowel or bladder problems

After surgery for vaginal cancer, you might have problems with your bladder or bowel, for example, difficulty having a poo (constipation). This depends on the type of surgery you have.

Ask your surgeon if your operation is likely to affect how your bowel or bladder work. Let your doctor or specialist nurse know if you have any problems after surgery.