Surgery on the vagina is mainly undertaken for the surgical treatment of vaginal or cervical cancer. Vaginal reconstruction is necessary if a large part of the vagina is removed during the surgical procedure due to widespread cancer.

Vaginal cancer (vaginal carcinoma) occurs in the vagina itself; however, cervical cancer can also spill over from the cervix to the vagina. The surgical treatment in both cases consists of removing the tissue affected by the cancer from the vagina. If the disease is localised, the cancerous tissue is cut out without the vagina having to be removed. If the disease is in an advanced stage, larger portions of the vagina or even the entire vagina sometimes have to be removed. In such cases, it is possible to rebuild the vagina with vaginal reconstruction.

What preparations are carried out before the procedure?

Different clarifications and examinations are undertaken before the procedure. Ultrasound examination and vaginal endoscopy are among the standard clarifications. Sometimes computed tomography or MRI are also carried out. All blood-thinning medication must be discontinued before the procedure takes place. Sometimes the tumour is reduced in size with radiotherapy or chemotherapy before the surgery. Depending on the size of the tumour, the surgery to remove the vaginal cancer is carried out under local anaesthesia, spinal anaesthesia , or under general anaesthesia. If vaginal reconstruction is required, this takes place under general anaesthesia.

How is the operation carried out?

The surgery to remove the tumour depends on the size and the spread of the tumour. Smaller tumours can be removed while preserving the vagina. In the case of larger tumours, parts of the vagina or sometimes the entire vagina plus neighbouring organs such as the bladder have to be removed. The operation can be performed on an outpatient basis. 

Vaginal reconstruction is a complex operation which involves the construction of a new vagina. Autologous tissue such as muscles, colon and skin are used and transplanted in the process. The procedure takes several hours.

What is the success rate of this procedure?

The success rate of the vaginal surgery depends on the stage of the cancer. Radical removal of the vagina is usually only performed if the cancer can be treated effectively in the process. The goal of vaginal reconstruction is to enable women who have had vaginal cancer to have a satisfactory sex life. The surgery usually makes this possible.

What are the possible complications and risks of this procedure?

Radical vaginal removal after cancer is a complex operation which also affects neighbouring organs. The bladder, urethra or the anus must also often be included in the surgery. The complications and risks depend on the spread of the cancer. Vaginal reconstruction itself is associated with fewer risks. As with all surgery, the operation may lead to infections, post-operative haemorrhaging or blood clots (thromboses) in rare cases.

What happens after the operation?

After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, they can usually leave hospital in a few days. You should avoid lifting heavy objects and major physical exertion for some time after the surgery. A tissue expander is usually inserted for some time into the newly created vaginal channel. Sexual intercourse should be avoided until the reconstructed vagina has healed fully and functioning properly.

Depending on the stage of the cancer, further treatment (chemotherapy) is necessary. Regular follow-up checks should be carried out as well.

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