(120) GETTING C-LITERATE: ELUCIDATING BULBOCLITORAL ERECTILE TISSUE ANATOMY AND HISTOLOGY FOR APPLICATIONS IN CANCER SURVIVORSHIP
Authors: Greenwald L , Reidenberg J S , Downes M H , Collins V , Garcia-Barros M , Soto A , Thin T H , Cohen E , Brody R , Hannan J , Marshall D 
Published: June 2024

Abstract

Introduction
Sexual function is a crucial component of overall well-being and is emerging as an important factor in health outcomes across multiple healthcare fields, including oncology. The bulboclitoris, composed of the clitoris and vestibular bulbs, is an erectile organ that has been largely understudied in comparison to other sexual organs, such as the vagina and penis. Recently, sexual health advocates have increased visibility for the bulboclitoris, highlighting its significance, particularly for patients who have undergone surgical procedures, experienced trauma, or undergone cancer treatments in that region. A deeper understanding of this organ is essential for better appreciation of its role and for advancing the treatment of sexual morbidity.

Objective
We aim to characterize the anatomic and histopathologic characteristics of the bulboclitoral erectile tissues using human cadaveric specimen dissection, histology, and immunohistochemistry. We hope that our findings can both serve as a translational bridge to understanding the effects of radiation and other oncologic interventions on the bulboclitoris on a cellular level and to establish the bulboclitoris as a unified organ in peer reviewed anatomic literature.

Methods
We evaluated the bulboclitoral erectile tissues on a structural and cellular level using multiple modalities. In order to visualize the bulboclitoris organ in its anatomic position, we used gross anatomic dissection (n = 2) and cross-sectioning (n = 1). In order to characterize the neurovasculature, endocrine function, musculature, and other cellular characteristics of the erectile tissues, samples were taken from multiple sections of the dissected bulboclitoral organs and from rapid autopsy (n = 2) for histopathological and immunohistochemical staining. We are analyzing these tissues using four stains, hematoxylin and eosin (H&E), trichrome, toluidine blue, and elastin; and eight antibodies, endothelial nitric oxide synthase (eNOS), factor VIII, smooth muscle actin (SMA), desmin, protein gene product 9.5 (PGP 9.5), tyrosine hydroxylase, anti-estrogen receptor (anti-ER), and anti-androgen receptor (anti-AR), using penile tissue as a control.

Results
We present the results of the gross dissections and some preliminary results of the histopathological and immunohistochemical staining. These dissections confirm the visibility of the bulboclitoris in its specified anatomical location and provide support for the existence of the residual spongy part (RSP) connecting the cavernous and spongy structures. Distinct features of the bulboclitoral erectile tissues are visualized and highlighted on the digitally scanned slides. The results of the histopathological and immunohistochemical analyses will further elucidate the anatomy of the organ.

Conclusions
The bulboclitoris is an organ that plays an essential role in sexual function. Thus far we have found supportive evidence for the hypothesis that the bulboclitoral erectile tissues function as one organ, homologous to the penile erectile tissues, based on the presence of the residual spongy part (RSP). Greater understanding of the makeup and cellular composition of the erectile tissues has the potential to increase our understanding of various medical treatments on sexual function, provide the basis for objective markers that can help to quantify the impact of any preventive or mitigating interventions, and lay the foundation to inform design of appropriate interventions for the preservation of sexual function in cancer survivorship.

Disclosure
No.