Supportive care for vulvar cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, the organs and tissues removed during surgery, the type of treatment and side effects.

If you have been treated for vulvar cancer, you may have the following concerns.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Vulvar cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as:

• scars
• hair loss
• skin problems
• change in the shape or appearance of the vulva, or a complete removal of the vulva
• urinary incontinence
• sexual problems

Some of these changes can be temporary. Others will last for a long time or be permanent.

But treatment can affect your self-esteem or body image even if it does not affect how you look. Other people may not be able to see changes to your body, but you may still worry about how they now see you. This may affect your self-esteem, making you feel angry or upset, afraid to go out or worried that others will reject you.

Find out more about coping with body image and self-esteem worries.

Lymphedema is swelling that happens when lymph can’t flow normally and builds up in the soft tissues of a limb. Lymphedema usually happens in parts of the body where lymph nodes have been removed or damaged by cancer treatment.

You may have lymphedema in your legs if lymph nodes were removed from your pelvis or groin. Lymphedema is more likely to occur if you were also given radiation therapy to the pelvis.

If you develop lymphedema, your healthcare team can suggest ways to reduce swelling as much as possible and help prevent more fluid from building up. This may include elevating the limb, exercise, wearing compression stockings and physiotherapy. You can also ask for a referral to a healthcare professional who specializes in managing lymphedema.

Find out more about lymphedema.

Vulvar surgery can affect the opening of the urethra (the tube that carries urine from the bladder to the outside of the body). After surgery for vulvar cancer, you may find that the direction of the stream of urine changes or that there is a spray of urine. Sitting farther back on the toilet seat while urinating may help you direct the stream.

Many people continue to have strong, supportive relationships and a satisfying sex life after vulvar cancer. If sexual problems occur because of vulvar cancer treatment, there are ways to manage them.

Some of the side effects of cancer treatment that can make sex painful or difficult include:

• vaginal dryness caused by cancer treatments, such as radiation therapy or surgery (vaginal dryness can also be a symptom of menopause)
• vaginal narrowing caused by scarring after radiation therapy to the pelvic area
• treatment-induced menopause caused by cancer treatments, such as radiation therapy or surgery
• loss of sexual sensation caused by the removal of the clitoris

Some people may lose interest in having sex. It is common to have a decreased interest in sex around the time of diagnosis and treatment.

When you first start having sex after treatment, you may be afraid that it will be painful or that you won’t have an orgasm. The first attempts at being intimate with a partner may be disappointing. It may take time for the couple to feel comfortable with each other again. Some people and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.

Find out more about sex and intimacy and sexual problems for women.

You may be worried about whether you will be able to get pregnant and have children after cancer treatment.

The most common surgery for vulvar cancer (vulvectomy) usually does not affect your ability to become pregnant. But if you have had a pelvic exenteration, you will not be able to become pregnant because the ovaries, uterus and vagina are removed during this surgery.

Radiation therapy used to treat lymph nodes in the groin or pelvis often causes treatment-induced menopause. This side effect is often permanent and will affect your fertility.

Find out more about treatment-induced menopause.

After treatment, it’s common to worry that the cancer will come back. It is important to learn how to deal with these fears to maintain a good quality of life.

In addition to the support offered by the treatment team, a mental health professional, such as a social worker or counsellor, can help you learn how to cope and live with a diagnosis of vulvar cancer.

To make the decisions that are right for you, ask your healthcare team questions about supportive care.