Can clitoris-conserving surgery for early vulvar cancer improve the outcome in terms of quality of life and sexual sensation?

ObjectivesVulvar carcinomas (VC) and vulvar in situ cancers (VCIS) are rare genital malignancies. Total vulvectomy as the standard of care has been replaced by local excision during the early stages of the disease. We studied whether conservation of the clitoris in vulvar surgery has a positive effect on either the quality of life (QoL) or the sexual sensation of the patient.Study designIn a retrospective study, patients with and without clitoris-sparing surgery were interviewed using the Female Sexual Function Index questionnaire (FSFI) and the Short Form 12® questionnaire (SF-12). The frequencies of high and low levels and the medians were compared using the Cox-Mantel, Chi2 and Fisher's exact tests.ResultsWe identified 24 patients who had surgery in our department for VCIS or VC stage I/II, between 2006 and 2008. Ten of these patients required total inguinal lymphadenectomies and another five required sentinel node biopsies. In twelve patients, the clitoris had been spared, whereas in the remaining twelve, the clitoris had needed to be removed. These groups did not differ in terms of tumor size, stage, type of surgery or age of the patients. The evaluation of the SF-12 indicated high satisfaction in the physical scores for 33% of patients with clitoris-sparing surgery vs. 67% after clitoris resection (n.s.). For the mental domain, the rates were 58% and 67% (n.s.), respectively. In the FSFI, both groups showed comparable values <18 (n = 7) and >18 (n = 5) in sexual sensation.ConclusionReducing the surgical resection is oncologically acceptable, but improvement in the patients’ quality of life or sexual sensation is not achieved solely by conserving the clitoris.