(385) The Bulboclitoral Erectile Tissues: A Previously Unacknowledged Organ at Risk During Radiotherapy

Abstract

Abstract Introduction Loss of sexual function can be a devastating side effect of the radiotherapy techniques used in the treatment of pelvic area tumors. Direct damage to the erectile tissues caused by off-target effects of radiation contributes to this loss of function. Advances in radiation techniques allow for greater tissue sparing, offering the potential to minimize tissue toxicity during treatments for pelvic cancers. In radiation oncology practice, specific attention is given to preserving sexual function in well characterized anatomic areas of male sexual function; however, preservation of clitoral structures involved in sexual function has not been well explored. Incorporating previously unacknowledged sexual structures such as the clitoris and vestibular bulbs (bulboclitoris for short) into radiotherapy treatment planning may improve our ability to preserve the function of these structures, including arousal and orgasm, after pelvic radiotherapy. Such an approach normalizes and affirms sexual pleasure as an important aspect of sexual health in cancer survivorship for women and gender-diverse persons. Objective We aim to explore the anatomic and radiologic characteristics of bulboclitoral sexual structures to shed light on their potential therapeutic applications in radiotherapy. Methods We evaluated the presence and configuration of the bulboclitoral erectile tissues and their proximity to other organs in a multi-modality study. The morphological characteristics were assessed in human cadaveric specimens using gross anatomic dissection and cross-sectioning as well as cross-sectional imaging using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) (N=3). Results We present the CT, MRI, gross cross-sections, and 3D reconstruction of the bulboclitoral sexual structures. The presence and morphology of the female erectile tissues and adjacent structures are consistently demonstrated across modalities to inform anatomic delineation on radiotherapy planning scans. Conclusions The bulboclitoral erectile tissues are important structures in the pelvic region that have an essential role in sexual function. Attention to these previously unacknowledged structures has the potential to help improve patient outcomes in radiotherapy. In order to make this step, radiation oncologists can learn about the structures and their functions, and develop and apply advanced techniques to help preserve their integrity. Empowering radiotherapy clinicians with evidence for incorporating the anatomy, physiology and pathophysiology of organ function related to sexual pleasure in female persons with cancer provides an opportunity for tailored clinical decision-making and a more equitable distribution of advanced technologies that may preserve sexual function after cancer treatment. Disclosure No