Penile cancer significantly impacts patients' sexual activity, sexual function, sexual sensations, cosmesis and sexual wellbeing, and while considerable proportions of patients resume sexual activity following treatments including penectomy, rigorous prospective studies assessing valid and reliable patient reported outcome measures for sexual wellbeing besides sexual functioning are needed.
Key Findings
Results
Penile cancer and its treatments significantly impact multiple dimensions of sexual health including sexual activity, sexual function, sexual sensations, cosmesis, and sexual wellbeing.
The review examined evidence across all major treatment modalities including organ-sparing procedures, partial penectomy, total penectomy, and adjuvant therapies.
Sexual wellbeing as a distinct domain from sexual functioning remains underexplored in the existing literature.
The impact was characterized as 'significant' across all domains assessed.
Results
Considerable proportions of patients resume sexual activity following penile cancer treatments, even after the most invasive procedures including partial or total penectomy.
Sexual activity resumption was documented across the full spectrum of treatments: organ-sparing procedures, partial penectomy, total penectomy, and adjuvant therapies.
The review does not specify exact proportions but characterizes them as 'considerable.'
This finding applied even to patients undergoing total penectomy, the most radical surgical intervention.
Results
Organ-sparing surgeries can largely preserve sexual functioning, while more invasive treatments like partial or total penectomy result in greater declines in sexual function.
Post-surgical sexual functioning has mainly been assessed using the International Index of Erectile Functioning (IIEF).
A gradient of sexual function decline was observed corresponding to the invasiveness of the surgical approach.
Organ-sparing procedures were associated with greater preservation of sexual functioning compared to penectomy approaches.
Methods
The existing evidence base for sexual outcomes in penile cancer is methodologically limited, relying heavily on retrospective self-reporting and non-randomized comparisons.
Some studies asked men to report retrospectively on pre-surgical sexual functioning, introducing recall bias.
Comparative studies between surgical techniques used non-randomized samples.
The primary tool used to assess sexual outcomes has been the International Index of Erectile Functioning, which measures erectile function but not broader sexual wellbeing.
Reliable assessments of sexual wellbeing specifically are described as 'missing' from the literature.
Results
Patient perspectives on sexual sensations and penile appearance (cosmesis) following penile cancer treatment represent an emerging area of research.
Studies on patients' perspectives on sexual sensations and appearance are described as 'emerging.'
Cosmesis was identified as a distinct domain of sexual health impact alongside sexual activity, function, sensations, and wellbeing.
This suggests a shift toward more patient-centered outcome assessment beyond purely functional measures.
Conclusions
The review concludes that rigorous prospective studies using valid and reliable patient-reported outcome measures (PROMs) for sexual wellbeing are needed to fully understand the impact of penile cancer treatment on sexual health.
Current literature lacks prospective study designs assessing sexual outcomes in penile cancer.
The authors call specifically for PROMs that capture sexual wellbeing beyond sexual functioning.
The gap between what is currently measured (primarily erectile function via IIEF) and what matters to patients (broader sexual wellbeing) is identified as a key deficiency.
What This Means
This research review examined how penile cancer and its treatments affect men's sexual health. The authors looked at evidence across different treatment types, from less invasive organ-sparing surgeries to partial or total removal of the penis (penectomy), as well as additional therapies like radiation. They found that penile cancer has a significant impact on multiple aspects of sexuality including the ability to have sex, sexual function, physical sensations during sex, the appearance of the penis, and overall sexual wellbeing. Importantly, the research suggests that even after very invasive surgeries including complete penectomy, a notable proportion of men do resume some form of sexual activity.
The review also highlights that less invasive, organ-preserving surgeries tend to better protect sexual function compared to more radical procedures, which is an important consideration in treatment planning. However, the authors note that most studies have primarily measured erectile function using a standardized questionnaire (the International Index of Erectile Functioning), which does not capture the full picture of a man's sexual wellbeing, including emotional and relational aspects of sexuality.
This research suggests that there are important gaps in how sexual outcomes are currently studied in penile cancer patients. Most existing studies relied on patients remembering how they functioned sexually before surgery, or compared different surgical approaches without random assignment, which can introduce bias. The authors call for better-designed future studies that use more comprehensive, patient-centered tools to measure sexual wellbeing — not just physical function — so that doctors can better counsel patients and support their sexual health throughout and after treatment.
Roumieux C, Vandermaesen K, Dancet E, Albersen M. (2025). Penile cancer treatment and sexuality: a narrative review.. International journal of impotence research. https://doi.org/10.1038/s41443-025-01095-6