Clitoral reconstructive surgery in vulvar cancer patients: a qualitative study about motives, experiences, and outcomes
Abstract
Background
Vulvar cancer involving the clitoral region often requires radical excision, including (partial) resection of the clitoris, which can impair quality of life and sexual function, and although reconstructive flap surgery has long been used in patients with vulvar carcinoma to restore anatomy and overall function, clitoral-specific reconstructive procedures remain poorly described.
Aim
To evaluate patient motives, experiences, and outcomes following clitoral reconstruction in women with vulvar cancer.
Methods
Semi-structured interviews were conducted with vulvar cancer patients who underwent clitoral reconstructive (CR) surgery between 2019 and 2023 in a Dutch university medical center until data saturation was reached.
Outcomes
Motives, experiences, and outcomes as psychosexual functioning were analyzed using open coding.
Results
A total of 12 women participated in the study. Five principal themes were identified: preoperative motivation, the decision-making process, surgical outcomes, postoperative experiences, and the psychosocial impact. The primary motive for undergoing clitoral reconstruction was functional recovery. The majority, 10 out of 12 women, experienced functional recovery. The procedure contributed to an improved sense of femininity, which emphasizes the psychosocial impact of vulvar cancer surgery. Overall, the experiences with pre- and postoperative guidance were considered adequate, with the availability of written information and attention to open communication postoperatively on sexual functioning cited as areas for improvement.
Clinical Implications
These findings underscore the importance of addressing potential improvements for sexual health concerns in women diagnosed with vulvar cancer.
Strength and Limitations
A key strength of this study is its qualitative design, which enabled a nuanced exploration of patient motives, experiences, and functional outcomes following CR surgery. A limitation is that we did not include women who did not undergo clitoral reconstruction, preventing comparison of functional and psychosocial outcomes between groups.
Conclusion
Clitoral reconstructive surgery for women with vulvar cancer appears meaningful and has the potential to improve sexual function and overall well-being. These findings underscore the need for prospective studies to refine techniques and long-term outcomes.
