What is removed
In the vulva area there are sebaceous gland cysts, papillomas and condylomas, fibromas, lipomas, and hidradenomas. Most of them are safe, but must be removed: they are injured by underwear and during sexual activity, become inflamed, interfere with hygiene and cause discomfort. The formation is excised within healthy tissue, the defect is sutured with absorbable suture material. Histological examination is mandatory: vulvar cancer at an early stage may look like a harmless formation, and its timely detection fundamentally changes the prognosis. Particular vigilance is required for discoloration, ulceration and rapid growth.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.