Supportive care for vulvar cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of vulvar cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from vulvar cancer and adjusting to life after treatment is different for each woman, depending on the stage of the cancer, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for vulvar cancer may have the following concerns.

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Vulvar cancer and its treatments can affect a woman’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• scars
• skin changes
• change in shape and appearance of the vulva and sometimes complete removal of the vulva
• changes to body functions such as urination
• sexual problems

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

For many women, body image and how they think other people see them is closely linked to self-esteem. It may be a real concern for them and can cause considerable distress. They may be afraid to go out, be afraid others will reject them or feel angry or upset, even if the effects of treatment may not show on the outside of the body.

Find out more about how to cope with problems of self-esteem and body image.

Lymphedema is a chronic form of swelling that occurs when lymph fluid builds up in tissues. It usually occurs in parts of the body where large numbers of lymph nodes have been removed.

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 further fluid buildup. This may include elevating the limb, exercise, physical therapy and pain management. 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, some women 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 urine stream.

Many women 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 narrowing caused by scarring after radiation therapy to the pelvic area
• treatment-induced menopause caused by cancer treatments, such as radiation therapy or surgery

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

When the woman first starts having sex after treatment, she may be afraid that it will be painful or that she will not 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 women 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 sexuality and cancer and sexual problems for women.

Younger women diagnosed with vulvar cancer may have concerns about their ability to get pregnant and have children after treatment is finished.

The most common surgery for vulvar cancer (vulvectomy) does not affect a woman’s ability to become pregnant or to have children. But women who have had a pelvic exenteration 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 may cause treatment-induced menopause. This side effect is often permanent and will affect fertility.

Find out more about treatment-induced menopause.

Many women who are treated for vulvar cancer 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.