New surgery restores the clitoris after vulvar cancer

Nearly forty years after doctors first reconstructed a penis following cancer surgery, women are finally getting a comparable option. A team at Radboud university medical center (Radboudumc) has designed a technique that restores the clitoris when part of it has to be removed to treat vulvar cancer. Of the first 23 women who had the operation, nine in ten were able to experience a clitoral orgasm again.

Life-saving, but at a cost

About 450 women in the Netherlands are diagnosed with vulvar cancer each year. Surgery is the main treatment, and it often saves lives. But in roughly a quarter of cases, the tumour sits in or around the clitoris, and surgeons have to remove part of it.

Until now, the standard approach was simply to close the wound. What remained of the clitoris ended up buried beneath a layer of skin. According to gynaecologic oncologist Mieke ten Eikelder, little thought was given to quality of life afterwards, or to whether an orgasm would still be possible.

For men, reconstructive surgery after penile cancer has existed since 1987. Ten Eikelder and plastic surgeon Tim Nijhuis felt it was long overdue for women to have the same.

A new tip, made from the inside of the cheek

The operation starts once the tumour has been removed. The surgeons carefully free the bundles of nerves that give the clitoris its sensitivity. They then reposition these nerves to form a new tip of the clitoris.

To cover it, they use a small graft taken from the inside of the patient's cheek. That might sound unusual, but the lining of the mouth closely resembles the tissue of the vulva. Because the nerves themselves are preserved and moved rather than cut away, the new clitoris keeps its feeling.

The reconstruction adds only about fifteen minutes to the cancer operation.

Feeling returns within months

The results so far are promising. Of the first 23 women treated, 90% were able to have a clitoral orgasm again, typically three to six months after surgery. The outcomes of the first 18 of these patients have now been published in the journal Gynecologic Oncology.

Recovery takes some patience. In the early months, the clitoris can feel either oversensitive or less sensitive than before. By around a year, Ten Eikelder says, healing is at its best, and most women find that sensation has returned to roughly how it was before the operation.

The researchers note the technique may also help women who have undergone female genital mutilation.

Rolling out across the Netherlands

The technique is now being introduced nationwide as part of a research programme. Eight other Dutch hospitals besides Radboudumc treat vulvar cancer, and all of them are taking part. Their gynaecologic oncologists and plastic surgeons are learning the operation, and Nijhuis and Ten Eikelder are also training specialists from abroad.

The team stresses that this is still an early-stage technique. With funding from the Dutch Cancer Society (KWF), the hospitals will study whether the reconstruction truly improves sexual function and quality of life over time. They also want to establish how it can be offered safely as part of routine care.

Women who want to know whether the operation could be right for them are advised to talk to their own doctor. For now it is available at Radboudumc, with other Dutch centres expected to follow.