The short version
- Wide local excision removes the abnormal area with a margin of normal tissue around it. [1]
- Sentinel lymph node biopsy checks the first nodes in the groin, and for many women it replaces removing all of them.
- The lidocaine and Silvadene slurry can be applied to the vulva up to 4 times a day. [2]
- Cleanse the area at least once a day, usually with a sitz bath, and pat it completely dry. [2]
- Strenuous exercise, lifting over 20 pounds, and pelvic rest all continue until the area has healed, not until a set date. [2]
Your own discharge papers come first
Everything on this page is taken from the standard printed instructions this office gives patients. If the papers you were handed at discharge say something different, follow those. They were written for your operation. When the two disagree, call the office at 817-759-7065 and let us settle it.
After vulvar surgery
The printed skin-care and activity instructions. This is the one patients reread most.
The operations
The National Cancer Institute lists the surgical options for vulvar cancer as wide local excision, vulvectomy, sentinel lymph node biopsy, and laser surgery. [1]
- Wide local excision removes the cancer or the abnormal area along with a rim of normal tissue around it. [1] This is the most common operation and it preserves as much normal anatomy as possible.
- Vulvectomy removes part or all of the vulva. [1] How much depends entirely on where the disease is and how far it extends.
- Sentinel lymph node biopsy uses a dye or tracer to identify the first lymph node or two in the groin that the area drains into, and removes only those. [1] It answers the same question as removing all the groin nodes, with far less risk of long-term leg swelling.
- Laser surgery uses a focused beam of light to remove abnormal surface tissue. [1] It is used for precancerous change rather than invasive cancer.
Managing the pain
Pain or discomfort from the incision or the laser-treated site is expected. Take ibuprofen or Tylenol as needed, and use prescription pain medicine for breakthrough pain as prescribed. [2]
The instruction patients find most useful is this one: make a slurry of the lidocaine gel and the Silvadene cream and apply it to the vulva up to 4 times daily as needed. [2] Lidocaine numbs. Silvadene is an antibacterial cream that keeps the surface moist while it heals. Mixed together they spread more easily over tender tissue than either does alone. Both of these are prescribed. If you were not given them, call the office.
Skin care, which matters most
More of the outcome here depends on daily care than on anything that happened in the operating room. From the written instructions: [2]
- Cleanse the surgical area at least once daily. A sitz bath is the easiest way. Gently pat completely dry with a towel afterward.
- After urinating or a bowel movement, clean the vulvar area. Pour warm water over the vulva while sitting on the toilet, or take a sitz bath. Then gently pat dry.
- Check the surgical area daily for redness, swelling, or the wound opening.
- Avoid prolonged sitting.
- Wear loose-fitting clothing that will not rub or irritate the area.
Dry is the whole game
Every instruction above ends with patting dry, and that is not an accident. This area stays warm and moist on its own, and moisture is what keeps a wound from closing. Pat, do not rub, and take the extra thirty seconds to get it properly dry each time.
Activity and healing
- Exercise and lifting. Avoid strenuous exercise and lifting over 20 pounds until the surgical area has healed. [2]
- Pelvic rest. No intercourse, no douching, nothing in the vagina until the area has healed. [2]
- Movements to skip. Avoid movements that put stress on the vulva, such as squats and lunges. [2]
- Walking. Get up and walk at least every 1 to 2 hours in the days after surgery, to prevent blood clots in the legs. [2]
- Driving. Not the day of surgery, not if vulvar soreness slows your reaction time, and not while taking prescription pain medicine. [2]
- Water. Shower when you feel comfortable. Avoid lakes, swimming pools, and hot tubs until the site is healed. [2]
- Constipation. Avoid straining. Water and a stool softener twice daily as needed. [2]
- Follow-up. 2 week and 6 week visits, already booked. Check the blue folder or call 817-759-7019. [2]
When to call
When to seek care right away
Call the office now, or go to the emergency department, if you have:
- A fever of 101 degrees Fahrenheit or higher
- Chest pain or shortness of breath
- Nausea and vomiting you cannot get on top of
- An abundance of swelling or redness of the surgical area, or thick cloudy drainage
- Discharge from the surgical area that has a foul odor
- Trouble emptying your bladder, or burning when you urinate
- Increasing swelling in one leg
After vulvar surgery
The printed instructions given after a vulvar procedure.
Sources
- National Cancer Institute. Vulvar Cancer Treatment (PDQ) Patient Version. Updated September 18, 2024. https://www.cancer.gov/types/vulvar/patient/vulvar-treatment-pdq
- Vasques DR. Post Vulvar Procedure Instructions. The Center for Cancer and Blood Disorders, Fort Worth, TX. Patient handout supplied by the practice. pdfs/after-vulvar-procedure.pdf
Reviewed by DeEtte R. Vasques, DO, MBA · September 2026