Sexual minority patients face unique sexual function outcomes after prostate cancer treatment, including greater negative impact from anejaculation, urinary outcomes, and climacturia compared to heterosexual counterparts, while a marked lack of data on gender minority patients means meaningful conclusions for this group cannot be drawn.
Key Findings
Methods
Of 12,532 titles reviewed, 35 records met the inclusion criteria for this systematic review on sexual function outcomes in sexual and gender minority prostate cancer patients.
Search was conducted across EMBASE, Ovid MEDLINE, Global Health, APA PsycInfo, APA PsycTherapy, and AMED
PRISMA guidelines were followed (CRD42024609973)
Inclusion criteria required: SGM patients, reported sexual function outcomes, and prostate cancer treatment including surgery, radiotherapy, hormone therapy, chemotherapy, or focal therapy
Two independent reviewers conducted data extraction using line-by-line coding within NVivo software (15.0.0)
Results
Three main themes were identified from the data: sexual implications, psychological implications, and relational implications.
A mixed-methods approach was used to combine data
Independent critical appraisal was conducted using Joanna Briggs Institute checklists and the Mixed Methods Appraisal Tool
The findings are primarily applicable to sexual minority patients due to minimal inclusion of gender minorities in the existing data
Results
Compared to heterosexual counterparts, the negative impact of anejaculation, urinary outcomes, and climacturia was greater in sexual minority patients.
Anejaculation was identified as having a disproportionately greater negative impact on sexual minority patients compared to heterosexual men
Urinary outcomes following prostate cancer treatment were found to be more negatively impactful in sexual minority patients
Climacturia (orgasm-associated urinary incontinence) was also identified as having greater negative impact in sexual minority patients
These outcomes reflect the unique sexual practices and concerns of sexual minority patients that differ from heterosexual men
Results
Sexual minority patients are more likely to experience a change in 'sex-role' following prostate cancer treatment, which can be detrimental to their identity and lead to loss of their 'place' in their sexual community.
Change in sex-role was identified as a unique challenge specific to sexual minority patients not typically experienced by heterosexual counterparts
This sex-role change was linked to impacts on patient identity
Loss of 'place' within the sexual community was identified as a consequence of sex-role change
This finding fell within the relational implications theme identified by the review
Results
There is a marked lack of data on gender minority patients with prostate cancer, meaning meaningful conclusions for this group cannot be drawn.
The findings of the review are primarily applicable to sexual minority patients due to minimal inclusion of gender minorities in the existing literature
The gap in literature on gender minority patients was explicitly identified as a significant limitation
The authors note that gender minority patients represent an underserved population with unmet research needs in this area
Conclusions
Current patient-reported outcome measures (PROMs) fail to capture the full spectrum of sexual outcomes relevant to sexual and gender minority prostate cancer patients.
Many sexual outcomes relevant to sexual and gender minority patients are currently overlooked by existing PROMs
The Sexual Minorities and Prostate Cancer Scale (SMACS) is identified as 'a promising start to inclusive PROMs'
The review aims to guide the development of more inclusive PROMs
Greater awareness and understanding among healthcare professionals is recommended to allow them to provide appropriate information on how treatment impacts sexual activities
Conclusions
Sexual minority patients face unique sexual function outcomes after prostate cancer treatment that differ from those experienced by heterosexual men, and increased awareness and education are crucial to improving care and outcomes in this underserved population.
The impact of prostate cancer treatments on sexual function outcomes is described as 'poorly understood in heterosexual men and even less so in sexual and gender minority patients'
SGM patients are described as an 'underserved population'
Increased awareness and education among healthcare professionals are identified as crucial steps for improving care
The review identifies unique challenges that prostate cancer treatment presents to this population across sexual, psychological, and relational domains
What This Means
This research suggests that gay, bisexual, and other sexual minority men who are diagnosed with prostate cancer face a distinct set of challenges related to sexual function after treatment that are different from — and in some cases more severe than — those faced by heterosexual men. Specifically, side effects such as the inability to ejaculate (anejaculation), bladder leakage during orgasm (climacturia), and urinary problems have a greater negative impact on sexual minority patients. These men are also more likely to experience a change in their sexual role (such as switching from an insertive to a receptive role, or vice versa), which can harm their sense of identity and their sense of belonging within their sexual community. The study also found psychological and relationship-related impacts as major themes, reflecting how interconnected sexual function is with mental wellbeing and intimate partnerships in this population.
The review, which analyzed 35 studies drawn from over 12,000 titles, also highlights a critical gap in the medical literature: almost no research has been done on transgender and gender-diverse people who develop prostate cancer, making it impossible to draw conclusions about that group's experiences. Additionally, the tools currently used by healthcare systems to measure how cancer treatment affects patients' quality of life (called patient-reported outcome measures, or PROMs) do not adequately capture the sexual experiences and concerns of sexual and gender minority patients, meaning important problems may go undetected and unaddressed.
This research suggests that healthcare professionals need greater awareness and education about the unique needs of sexual and gender minority prostate cancer patients in order to provide appropriate counseling and support. It also suggests that new, more inclusive measurement tools — such as the Sexual Minorities and Prostate Cancer Scale (SMACS) highlighted in the review — need to be developed and adopted to ensure this underserved population receives equitable care.
Check Your Own Numbers
Upload your bloodwork. We'll cross-reference your results against this study and 4,700 others.
Katy-Anne Burr, Ching-Hao Chen, Sanika Kharwadkar, Wai Miu Emma Liu, A. Cotton, T. Yap. (2026). Sexual function outcomes following prostate cancer treatment in sexual and gender minority populations: a mixed-methods systematic review. Translational Andrology and Urology. https://doi.org/10.21037/tau-2026-0270