To describe an anatomically informed clitoral reconstruction technique after vulvar cancer surgery and assess postoperative function and complications.
Approach:
Design and participants: Single-center case series of 18 patients with vulvar cancer who underwent tumor excision and clitoral reconstruction.
Technique: After tumor removal, residual clitoral tissue was mobilized by releasing the suspensory ligament while preserving neurovascular structures, then covered with a graft and a newly created clitoral hood.
Assessment: Researchers assessed perioperative characteristics, complications, clitoral sensation, and ability to achieve clitoral orgasm.
Key Findings:
Clitoral sensation was preserved in 16 of 18 patients (89%); reports included sensation comparable to baseline in 9, reduced sensitivity in 4, and increased sensitivity in 2.
Sixteen patients (89%) reported being able to achieve clitoral orgasm after surgery. Median time to regain orgasmic function was 3.5 months (range, 1–12 months).
Reconstruction added an estimated 15 minutes to operative time. Seven patients had vulvar or inguinal complications; 2 had complications specifically related to reconstruction.
After the team shifted from full-thickness skin grafts to buccal or vaginal mucosal grafts, all patients treated with the refined technique reported equal or increased sensation. The case series does not establish comparative superiority of graft types.
Interpretation:
In this small case series, reconstruction was followed by reported preservation of sensation and orgasmic function in most patients. The study had no systematic comparison group, so the functional benefit attributable to reconstruction is uncertain.
Limitations:
Early experience involving 18 patients at a single center.
No systematic comparison with patients who underwent clitoral excision without reconstruction.
Sexual function was primarily self-reported rather than assessed with validated patient-reported outcome measures.
Limited follow-up prevented assessment of long-term sensory recovery and oncologic outcomes.
Conclusion:
The authors stated that prospective studies with longer follow-up and multicenter collaboration are needed. They considered the approach unlikely to adversely affect oncologic outcomes but noted that long-term follow-up is needed to confirm safety.
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