Preserving Sexual Function After Cancer
- There have been some incredible advancements when it comes to preserving sexual function in women with gynecologic cancer in recent years
- For vulvar cancer, clitoral-sparing surgery treats the disease while sparing as much of the outer genitalia as possible, improving sexual function post-treatment
- However, this treatment can currently only be given to women with early-stage disease
It's no surprise that inadequate devotion has been paid to preserving the clitoris in thousands of gynecologic (particularly vulvar) cancer patients each year. The history of misinformation surrounding the clitoris and the criminalization of the clitoris since the (near) dawn of time is too lengthy to summarize, but the following brief piece of history should clear things up. An accurate anatomical description of the internal clitoris was not discovered until 1998.
Read MoreWith the world's first anatomically accurate description of the clitoris emerging in 2005, it's safe to say the clitoris hasn't exactly been prioritized in the study of anatomy and medicine.
But that's changing.
As our global society progresses to understand the importance of sexual function and the right to sexual pleasure and safety for all people, scientists and medical professionals are beginning to understand that preservation of the clitoris is paramount to cancer patients and survivors' quality of life, hence the rise of oncosexology (a multidisciplinary approach to manage sexual health and intimacy in oncology patients).
This article will focus on the surgical treatment of vulvar cancer and options for preserving sexual function during treatment.
What is Vulvar Cancer?
Vulvar cancer forms as a lump or sore of malignant cells on the vulva (the outer surface of the female genitalia). The two most common types of vulvar cancer are:
- Vulvar melanoma: cancer that begins in pigment-producing cells found inside the skin of the vulva.
- Vulvar squamous cell carcinoma: cancer that begins in thin flat cells that line the surface of the vulva. Approximately 90 percent of instances of vulvar cancer are squamous cell carcinoma.
This cancer can develop at any age, but most commonly affects post-menopausal women. Risk factors for developing vulvar cancer include aging, a compromised immune system, smoking, exposure to human papillomavirus (HPV) and skin conditions involving the vulva. With approximately 6,190 new cases of vulvar cancer diagnosed in the U.S. each year (accounting for 6 percent of gynecologic cancers), vulvar cancer is relatively rare, but its impact can be truly devastating.
How is it Treated?
Until recently (about as long as we've had an anatomically correct model of the clitoris), a total vulvectomy has been the standard of care for treating vulvar cancer. This invasive procedure involves partial or full removal of the vulva, including the labia minora and majora (inner lips and outer lips of the genitals), urethra, vaginal opening, lymph nodes in the groin and often, the glans clitoris. Note that many descriptions of a total vulvectomy reference "removing the clitoris." This language is dated and actually refers to the glans clitoris (the external portion of the clitoris), not the eight-to-ten centimeter structure within the pelvis.
Enter: clitoral-sparing surgery.
Also referred to as clitoral-conservation surgery, this new method has replaced total vulvectomy as the standard of care for treating vulvar cancer. Although currently only available to those in the early stages of vulvar cancer, clitoral-sparing surgery involves localized excision of the cancer from the vulva, sparing as much of the outer genitalia as possible and improving sexual function outcomes post-treatment without increasing the risk of recurrence. Other variables that impact a patient's eligibility for clitoral-sparing surgery include the location of the cancerous growth on the vulva and the distance between the clitoris and vaginal opening.
Why is Clitoral Preservation so Important?
Surgical treatment of vulvar cancer is proven to negatively impact women's sexual function and pleasure, quality of life and even satisfaction in partnered relationships. We know that these factors can have devastating effects on women's social and psychological well-being. So why is the preservation of women's sexual function during cancer treatment (and in the general population) so understudied?
Unfortunately, very little research has been devoted to the sexual health of postoperative gynecologic cancer patients. Ample more methodological studies are required to fully understand the workings of female pleasure and sexual function in vulvar cancer patients. But recent advancements in clitoral-sparing surgical treatment give us hope for a future where women's sexual health is equally prioritized.
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