Post-Operative Instructions for Vulvar Surgery
The two most common problems encountered by patients who have had surgery on the vulva (labia and/or area around the vaginal opening) are: 1) problems related to sitting down on this tender area after surgery 2) Problems caused by infection.
For the first several days after your surgery (longer for patients with bigger operations) it is best to avoid putting direct pressure on the stitches. This means avoid the sitting position. Lying down, on your back, sides, or even stomach, or reclining, such as in a La-Z boy recliner, with your back part way down and your legs up, will help keep the pressure of your body’s weight off the sutured area. This will have two benefits – less pain and swelling, and a lower likelihood of popping or tearing your stitches. Limited walking is fine, but most of your time at home for the first 7-14 days should be either spent lying down or reclining, not sitting. Squatting, and other activities that put a lot of strain on your stitches should be particularly avoided.
Infection can be a problem because of the large number of bacteria that everyone has in the genital area. Good hygiene is especially important after surgery to prevent an infection from setting in. Use the rinse bottle each time you use the restroom and pat yourself gently dry with a soft towel or tissue. Patting is less painful than rubbing or wiping and less likely to hurt your incision. Try to take a lukewarm or cool sitz bath in the tub once, or preferably twice a day, and make an effort to gently rinse the area with water. Alternatively, showers can be taken, but extra effort will be needed to gently direct the water to the vulvar area to rinse and clean thoroughly.
Comfort Measures:
If you have had a laser surgery, you will probably receive Silvadene cream at discharge. This is a soothing, anti-bacterial cream that will feel good and help prevent infections. Apply it twice a day, after sitz baths. If you were sent home with antibiotic cream, it also should be used twice a day, after sitz bath, and/or at bedtime.
Most patients prefer to wear loose-fitting clothing during the healing phase. Avoid tight, occlusive pants that may chafe. Robes or skirts, without underwear, are fine around the house.
Many patients, especially those who have had laser surgery, find the application of cool or lukewarm tea bags (such as large, family sized iced tea bags) to be soothing. This can be done as often as is comfortable.
Discharge & Other Problems:
It is normal to have a slight-to-moderate amount of discharge after vulvar surgery. This can range in color from yellow to blood tinged. On days of high activity, you may have bright red spotting. This is OK. What is NOT normal is heaving bleeding, or discharge with foul odor, especially if it is associated with increasing pain, redness, or fever. These symptoms should be reported immediately.
Follow-Up:
I would like to see you back in the office about 2-3 weeks after surgery. At this time, if your stitches are irritating to you, they can usually be removed. Otherwise, they will dissolve in about 6 weeks. Please call or come in sooner than your 2-3 week appointment if you have a fever over 100, progressive pain, increasing or foul smelling discharge or other concerns. Depending on the extent of your surgery, you may have sore feeling with sitting for up to 10 weeks (although some women have significantly less, and a few, more). Intercourse should be avoided until the first post-operative visit 2-3 weeks. At that time, depending on healing, an appropriate time to resume sexual relations can be discussed.
