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The "Undefined and Ignored Normal Tissue" Bulboclitoral Complex in Locally Advanced Cervical Cancer Treated with

Kamuran Ibis¹, Mahmut Hudai Aydin¹, Korhan Kokce¹

¹Department of Radiation Oncology, Institute of Oncology, Istanbul University, 34093 Istanbul, Türkiye.

Medicina (Kaunas, Lithuania)

|January 28, 2026

Summary

Protecting the bulboclitoral complex (BCC) during gynecological cancer radiotherapy significantly reduces radiation dose. This study demonstrates that contouring the BCC as an organ at risk improves radiation protection and patient sexual health outcomes.

Keywords:

clitoris gynecology radiotherapy sexual health uterine cervical neoplasms vagina women

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Area of Science:

Gynecologic Oncology
Radiation Oncology
Female Sexual Health

Background:

The bulboclitoral complex (BCC) is crucial for female sexual health but is not recognized as an organ at risk in gynecological cancer radiotherapy guidelines.
There is a lack of established dose constraints for the BCC in radiation therapy planning.

Purpose of the Study:

To evaluate the dosimetric impact of contouring the bulboclitoral complex (BCC) as an organ at risk in radiotherapy planning for locally advanced cervical cancer.
To assess the feasibility of reducing radiation dose to the BCC using advanced planning techniques.

Main Methods:

Retrospective analysis of CT scans from 20 patients with locally advanced cervical cancer.
Volumetric Modulated Arc Therapy (VMAT) plans were created with and without sparing the BCC (PTV-standard vs. PTV-BCC spared).
Comparison of BCC radiation doses (Dmax, V45) between the two planning techniques using paired t-tests.

Main Results:

The median BCC volume was 17.6 cm³.
The PTV-BCC spared plan significantly reduced the maximum BCC dose (median 28.81 Gy vs. 49.07 Gy, p < 0.001).
The percentage of BCC volume receiving 45 Gy (V45) was significantly reduced to 0% in the PTV-BCC spared plan (p ≤ 0.001).

Conclusions:

Contouring the bulboclitoral complex (BCC) as an organ at risk allows for significant dosimetric protection during radiotherapy for gynecological cancers.
Implementing BCC sparing in radiotherapy planning is feasible and can substantially reduce radiation exposure.
Further clinical studies are warranted to investigate the impact of BCC radiation protection on patient sexual health.