Clitoral reconstructive surgery for patients with vulvar carcinoma

Vulvar carcinoma involving the clitoral region often necessitates partial or complete excision of the clitoris, with profound psychosexual and functional impact. While vulvar reconstruction using flaps is standard practice, clitoral reconstruction remains uncommon. We describe a technique to reconstruct both anatomically and functionally the clitoris, incorporating the Foldès method, originally developed for reconstruction after female genital mutilation/cutting (FGM/C).

To give an anatomical overview of the clitoris and describe the anatomical foundations and surgical technique for clitoral reconstruction after oncological excision and report postoperative outcomes.

We provide an anatomical overview and a step-by-step description of clitoral reconstruction after vulvar carcinoma surgery. Additionally, a case series of 18 patients diagnosed with vulvar cancer who underwent surgical treatment, including clitoral reconstruction, was reported, detailing patient and surgical characteristics as well as postoperative clitoral sensation. Post procedure complications were described.

A combined approach of careful margin assessment, clitoral mobilization via suspensory ligament release, mucosal graft coverage, and neohood formation preserves neurovascular integrity while restoring clitoral anatomy and function. The case series reported an ability to achieve a clitoral orgasm post procedure of 88.9% (16/18), estimated additional surgical time of 15  minutes and a postoperative complication rate of 11.1% (2/18) concerning the clitoral reconstruction specifically.

Clitoral reconstruction in vulvar carcinoma surgery is technically feasible, preserves anatomical landmarks, reporting low incidence of complications, and may mitigate psychosexual morbidity without compromising oncological safety. Further prospective evaluation is warranted.