Efeitos da Vulvectomia na Sexualidade

O câncer de vulva pode ser tratado cirurgicamente com a remoção de toda ou parte da vulva. Esta cirurgia é denominada vulvectomia. A vulvectomia parcial remove apenas a área afetada e uma margem ao redor do tumor. A vulvectomia radical modificada remove a área afetada e tecido para uma margem clara, o que inclui a retirada de alguns gânglios linfáticos da região da virilha. Se existir células cancerosas no clitóris ou próximas dele, pode ser necessário a remoção .

A cirurgia mais extensa é chamada de vulvectomia radical, que raramente é realizada. Neste procedimento se remove toda vulva, o que inclui os lábios menores e maiores e o clitóris e, muitas vezes, os gânglios linfáticos que drenam o líquido linfático da vulva. A vagina, útero e ovários permanecem intactos. Os médicos muitas vezes tentam poupar a maior parte possível da vulva. 

Após a remoção de parte ou da totalidade da vulva, as mulheres muitas vezes sentem desconforto ao usar calças apertadas ou jeans já que o tecido em torno do orifício uretral e vaginal não existe mais. A área ao redor da vagina também perde sua aparência normal.

As mulheres muitas vezes temem que seus parceiros não gostem ou deixem de amá-las devido a cicatriz e perda da genitália externa, especialmente se eles praticam estimulação oral como parte da relação sexual. Algumas mulheres podem realizar a cirurgia de reconstrução dos lábios menores e maiores, o que melhora a aparência da vulva, mas a sensação será diferente.

Ao tocar a área ao redor da vagina e especialmente a uretra, uma carícia leve e o uso de um lubrificante podem ajudar a prevenir irritação e dor. Se o tecido cicatricial diminui o orifício de entrada da vagina, a penetração pode ser dolorosa. O uso de dilatadores vaginais podem ajudar. Quando a cicatriz é grande, o cirurgião pode usar enxertos de pele para alargar a entrada. O uso de hidratantes vaginais também pode ser muito útil para evitar o desconforto.

Quando os gânglios linfáticos da virilha são removidos, as mulheres podem apresentar inchaço da região genital ou pernas. Embora o edema melhore após cirurgia, pode se tornar um problema a longo prazo. Esta condição, chamada de linfedema, pode causar dor, sensação de peso e fadiga. Também pode ser um problema durante a relação sexual. 

Orgasmo após Vulvectomia

Mulheres que fizeram vulvectomia podem ter problemas para atingir o orgasmo, dependendo de quanto da vulva foi removida. A genitália externa, especialmente o clitóris, é importante no prazer sexual de uma mulher. Se a cirurgia tiver removido o clitóris e parte da vagina, podem não ser possíveis mais orgasmos. Algumas mulheres acham que acariciar a vagina  perto da parte anterior da bexiga pode ser prazeroso. 

Após a vulvectomia, algumas mulheres notam dormência em sua área genital. Essa sensação melhora paulatinamente em alguns meses.

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