Clitoral reconstruction following surgery for vulvar carcinoma may preserve sensation and orgasmic function, with nearly 90% of patients reporting both outcomes following the procedure.
Researchers described an anatomically informed reconstructive technique and evaluated outcomes among 18 patients with vulvar cancer who underwent oncologic excision with clitoral reconstruction at a single center. The technique was adapted from the Foldès method originally developed for reconstruction following female genital mutilation or cutting.
The researchers assessed perioperative characteristics, postoperative complications, clitoral sensation, and the ability to achieve clitoral orgasm. The procedure involved complete tumor excision followed by mobilization of residual clitoral tissue through release of the suspensory ligament while preserving the neurovascular structures. The mobilized tissue was then covered with a graft and a new clitoral hood was created.
Following reconstruction, clitoral sensibility was preserved in 89% (n = 16) of patients. Further, 9 patients reported sensation comparable with their preoperative baseline, 4 reported reduced sensitivity, and 2 reported increased sensitivity. Similarly, 89% (n = 16) reported being able to achieve clitoral orgasm postsurgery. The median time to regain orgasmic function was 3.5 months, with recovery ranging from 1 to 12 months.
The reconstruction added an estimated 15 minutes to operative time. Postoperative complications involving the vulvar or inguinal regions occurred in 7 patients, but complications specifically related to the reconstruction occurred in 2 patients. One patient developed minor granulation tissue at the graft site, and 1 experienced clitoral pain associated with constricting scar tissue that required reoperation to release the adhesion; the pain subsequently resolved.
Full-thickness skin grafts were initially used in 7 patients. Although most regained clitoral sensation, 4 reported diminished sensation or numbness compared with their preoperative state. The researchers transitioned to buccal or vaginal mucosal grafts, and all patients treated with the refined technique reported equal or increased postoperative sensation. Because these findings arose during an evolving surgical approach in a small case series, they do not establish comparative superiority of the mucosal-graft technique.
Tumor removal preceded reconstruction and the procedure used residual clitoral tissue without interfering with margin assessment. The researchers considered the approach unlikely to adversely affect oncologic outcomes but noted that long-term follow-up remains necessary to confirm safety.
The study had several limitations. The 18-patient cohort represented early experience at a single center, and there was no systematic comparison with patients who underwent clitoral excision without reconstruction. As a result, the magnitude of any functional benefit attributable to reconstruction remains uncertain. Sexual function was primarily self-reported rather than measured using validated patient-reported outcome measures, and limited follow-up prevented assessment of the long-term durability of sensory recovery and oncologic outcomes.
“Prospective studies with longer follow-up and collaborative multicenter efforts are needed,” wrote lead study author Mieke ten Eikelder, of the Department of Obstetrics and Gynaecology at Radboud University Medical Center in the Netherlands, and colleagues.
The study authors reported no conflicts of interest.
Source: Gynecologic Oncology
