Novel surgical technique restores clitoral sensation using buccal mucosa graft

For women who lose part of their clitoris because of vulvar cancer, a clitoral reconstruction procedure has now been developed for the first time. This comes forty years after the first penile reconstruction surgery. Results in the initial group of patients are encouraging.

Surgery for vulvar cancer can save lives, but it can also significantly affect a woman's sexual function and quality of life. 'When the tumor is located in or around the clitoris, we sometimes have to remove part of it', explains gynecologic oncologist Mieke ten Eikelder from Radboudumc.

'Until now, the wound was simply closed afterward, and the clitoris disappeared beneath a layer of skin, with little attention paid to quality of life or whether orgasm would still be possible.'

The first reconstructive surgery for the penis after cancer dates back to 1987. It was therefore high time to develop a method to restore the sexual function of the clitoris as well. Plastic surgeon Tim Nijhuis, together with Ten Eikelder, developed a new surgical technique. Nijhuis: 'Once the tumor has been removed, the nerve bundles are released and repositioned to create a new clitoral tip. We then cover it with a small graft of buccal mucosa. This tissue type closely resembles the tissue found around the vulva.' This approach helps preserve clitoral sensation.

Clitoral orgasm

Among the first 23 women with vulvar cancer who underwent the reconstruction procedure, ninety percent were able to achieve a clitoral orgasm again after surgery. This typically occurred between three and six months after the operation.

Initially, the clitoris may be overly sensitive or, conversely, less sensitive. However, recovery is generally optimal after one year. In most women, sensation returns to a level comparable to what it was before surgery."

Mieke ten Eikelder, Radboud University Medical Center

Approximately 450 women in the Netherlands are diagnosed with vulvar cancer each year. In about one-quarter of these cases, the clitoris or surrounding area is involved. The reconstruction adds only about fifteen minutes to the operation. In addition to vulvar cancer treatment, this reconstructive technique may also help women who have suffered genital mutilation.

Training other centers

The clitoral reconstruction procedure is now being introduced nationwide as part of a scientific research program. Alongside Radboudumc, eight other Dutch hospitals treat vulvar cancer. All of them are participating in a follow-up project in which gynecologic oncologists and plastic surgeons will be trained in the new technique. In addition, Nijhuis and Ten Eikelder are currently training specialists from other countries.

While the initial results are encouraging, the researchers emphasize that further study is needed. With financial support from the Dutch Cancer Society, they will work together with other Dutch hospitals to determine whether the reconstruction truly improves sexual function and quality of life, and how the technique can be safely integrated into everyday clinical care.