Problems after vaginal cancer surgery

There is a risk of problems or complications after any operation.

Possible problems after vaginal cancer surgery include vaginal narrowing, and bladder or bowel problems. Other risks include infection and blood clots. 

Many problems are minor but some can be life threatening. Treating them as soon as possible is important.

Infections

You are at risk of getting an infection after an operation. This includes a wound, chest or urine infection. You will have antibiotics to reduce the risk of developing an infection after surgery. 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
• cough
• feeling sick
• swelling or redness around your wound and your wound might feel hot
• a strong smell or liquid oozing from your wound
• loss of appetite

Rarely for an infection in your wound, you may need another operation.

Blood clots

Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the veins. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.

There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:

• shortness of breath

• chest pain

• coughing up blood

• feeling dizzy or lightheaded

To prevent clots it's important to do the leg exercises that your nurse or physiotherapist taught you. Your nurse might also give you an injection just under the skin to help lower the risk whilst you are in hospital. You might need to carry on having these injections for 4 weeks, even after you go home. This depends on the type of operation you had.

Your nurse might teach you to do these injections yourself before you go home. Or a district nurse might come to your home to do them.

It's important to continue wearing compression stockings if you have been told to by your doctor.

Chest and breathing problems

Chest infections, including pneumonia, can be serious. 

You can lower your risk by:

• stopping smoking before your operation
• getting up and moving as soon as possible after your operation
• doing any breathing exercises your physiotherapist teaches you

If you get an infection you have antibiotics to treat it. 

Bleeding

There is a risk that you will bleed after your operation. The team looking after you will monitor you closely for signs of bleeding. The treatment you need depends on what is causing the bleeding and how much blood you lose. You might need a blood transfusion.

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 can happen to people who have not had their vagina removed or have had part of their vagina removed. You might find that penetrative sex is painful because of the narrowing.

Vaginal 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. A surgeon can sometimes use skin grafts to widen the vaginal opening if dilators have not worked.

Speak to your healthcare team if you have any problems or questions, or if you don’t feel comfortable with using dilators for any reason.

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.

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, you might have difficulty having a poo (constipation), or some pain when you pee. 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 healthcare team know straight away if you have any problems after surgery.