This operation includes removal of the contents of the pelvis, to include removal of the rectum and lower bowel, as well as the bladder and vagina and uterus and ovaries. Pelvic exeneration may be required when cancer is either extensive or recurrent. On the other hand, there is still insufficient data to predict which women will be able to function and be capable of having orgasms following surgery for cancer of the vulva. Similar cure rates for the conservative resection of the vulva versus the more radical vulvectomy have been encouraging and have led to reports that some women are capable of having orgasms after removal of the clitoris. Even the more conservative surgical resections with preservation of some normal anatomy may leave the patient with problems achieving orgasm. This surgery may narrow the vaginal entrance, as well as alter physical appearance. Cancer of the vulva may require extensive resection of the mons pubis, labia, or clitoris.

In addition, there may be a tendency for the posterior vaginal wall to lack the normal support after surgical removal of the rectum. When the rectum and distal colon are surgically removed, damage to the pelvic nerves may adversely affect sexual response. Colorectal cancer is the third leading cause of death from cancer in women in the United States. Again, preoperative counseling about potential side effects of the surgery can help patients prepare for any postoperative changes and minimize the overall impact of those changes.