After surgery for vaginal cancer

Your recovery will depend on the type of surgery you have.

When you wake up

Depending on what operation you have, you might wake up in the:

• theatre recovery area
• high dependency recovery unit
• intensive care unit

These units and wards can be busy and often noisy places. You might find it strange and disorientating. You will feel drowsy because of the anaesthetic and painkillers. 

The staff will check regularly to see if you need anything. There will be a call bell close by so that you can call for help whenever you need it.

When you wake up you might have:

• a little clip on your finger (a pulse oximeter) to measure your heart rate and blood oxygen levels

• an oxygen mask on for a while

• a blood pressure cuff on your arm

Tubes

When you wake up, you have several tubes in you. This can be frightening, so it helps to know what they’re for.

You may have:

• drips (intravenous infusions) for blood transfusions and for fluids until you are eating and drinking again 
• a tube into your bladder (catheter) to drain urine and monitor your urine output
• a very fine tube into your spine (an epidural), containing painkillers to control your pain
• tube down your nose and into your stomach to drain it and stop you feeling sick (nasogastric tube)
• a fine tube into the wound to drain away fluid and help the wound to heal (wound drain)
• a colostomy bag  if you have had part of your bowel removed
• a urostomy bag if you have had your bladder removed

Painkillers

It’s normal to have pain for the first week or so. You have painkillers to help.

It’s important to tell your healthcare team as soon as you feel any pain. They need your help to find the right type and dose of painkiller for you. Painkillers work best when you take them regularly, so take them as often as you are advised.

You might have an electric pump attached to your drip for painkillers after surgery. This is called patient controlled analgesia (PCA). You have a hand control with a button to press to give yourself extra painkillers as you need them. Use this whenever you need to, you can’t overdose because the machine is set to prevent this. Tell your nurse if you need to press the button often. You might need a higher dose in the pump.

For some operations, your anaesthetist may set up a spinal anaesthetic (epidural). This gives painkillers into the fluid around your spinal cord. It makes your body numb from the waist down.

You get painkillers to take home. Follow the instructions your nurse gives you about how often and when to take them. Contact your healthcare team if you still have pain or if it gets worse. 

Eating and drinking

You may not be able to eat or drink for a while when you wake up. This depends on the type of operation you have had. When you're allowed, you start with sips of water. Gradually the amount you can drink will increase. 

You might be able to eat and drink later the same day if you have had a wide local excision. It will be longer before you can eat properly if your operation has involved your bowel and bladder.

Your wound

Your surgeon might remove just the area containing the cancer cells if you have an early stage vaginal cancer. With this type of surgery, your wound will be inside your vagina.

You will have a wound between your legs if your surgeon needs to remove part of the external genital area. For example, if your cancer is in the lower third of your vagina you might need to have the lips of the vagina (the vulva) removed. 

You might have a scar down the centre of your tummy (a vertical scar) if you have the whole of your vagina removed. It might be quite a long scar down the centre of your tummy if you have your womb removed (hysterectomy).

You will have wounds in your groin if you have your lymph nodes removed.

Do ask your surgeon whether you are going to have a scar and what it will look like. Treatment for vaginal cancer is very individual and depends on the exact size and position of the tumour.

Any external wound from the operation will be covered with a dressing. Your nurse will check the dressing to see if your wounds need cleaning. Try to keep the dressing dry.

If you have wound drains, these stay in until they stop draining fluid. Your nurse will tell you how long this is likely to be.

Any stitches or wound clips stay in for about 10 days. You might have them taken out before you go home. Or you might go home with them still in place. You then go back to the hospital, or your GP practice, to have your stitches out. Or a district nurse might do this for you at home. Any internal wounds will have stitches that dissolve by themselves.

Vaginal bleeding

You may have some bleeding or spotting of blood from the vagina. It can sometimes look brown and can last up to six weeks after your surgery. Only use sanitary towels if you do have some bleeding. It is important not to use tampons as they can increase the risk of getting an infection.

Do call your healthcare team if the bleeding becomes heavy or is painful. 

Getting up

Getting up and walking might be difficult at first. Moving about helps you to get better, but you need to start gradually. Your nurses will encourage you to get out of bed and sit in a chair as soon as possible. This may be the day after surgery, or a day or two after. They will help you with any drips and drains.

The physiotherapist might visit you after your operation to help you with breathing and leg exercises.

Over the next couple of days, the tubes, bottles, and bags will be taken away. Then it will be much easier to get around.

Making Progress

After a few days, you are up and about more. Gradually you will start to feel better.

You might find it easier to have frequent, small meals at first if you have had major abdominal surgery. The hospital dietician can give you help and advice about managing your diet.

The stoma nurse will help you to manage your stoma if you have had a colostomy or urostomy.

After surgery on your tummy (abdomen), you need to rest at home for at least a month after coming out of the hospital.

The first outpatient appointment is usually a few weeks after the operation date. Check this with your nurse before you leave hospital. Until this time, don't do anything that puts pressure on your abdominal muscles and skin. For example, don't:

• vacuum
• do any heavy lifting
• drive

A short gentle walk every day is a good idea. You get some fresh air and you can gradually go further as you get your strength back. Do take it easy at first.

Having sex after surgery

Your doctor will tell you when it is safe for you to have sex after surgery. This is usually about 6 weeks afterwards when your wounds have healed. This reduces the risk of getting an infection. 

You may have to wait longer to start having sex after a vaginal reconstruction, your doctor will speak to you about this.

Emotional effects

Vaginal cancer surgery can have a big impact on your feelings and emotions. You are likely to have times when you feel very down and this is natural.

You can get support from your doctors and nurses, family and friends. You could think about counselling if you would like to talk to someone outside your own friends and family.

There are also other organisations that offer help and support.