Psychosexual Outcomes in Young Men with Testicular Cancer: A Systematic Review of Survivorship

Abstract

Introduction: Testicular cancer (TC) affects men primarily aged 20–40 years. Treatment (orchiectomy, chemotherapy, retroperitoneal lymph node dissection [RPLND]) may impact body image, sexual function, and fertility. This review synthesizes psychosexual outcomes in TC survivors.

Methods: We searched PsycINFO, MEDLINE, and CINAHL (2010–2023) for observational studies and RCTs measuring sexual function (IIEF) or distress (BDI, HADS) in TC survivors ≥1 year post-treatment, age ≤45 years at diagnosis. Excluded: prior psychiatric illness.

Results: Twenty-one studies (n=3,852) were analyzed. Erectile dysfunction prevalence was 18% (95%CI 14–23%), vs. 8% in age-matched controls. Orchiectomy alone had minimal impact, but post-chemotherapy survivors reported significantly lower orgasmic function (mean IIEF-orgasm difference −2.1, p=0.01). RPLND was associated with antegrade ejaculation loss in 31% (nerve-sparing reduced to 12%). Body image dissatisfaction was reported by 44%, particularly after chemotherapy.

Discussion: Psychosexual morbidity is substantial but underrecognized. Fear of recurrence and fertility concerns mediate much of the distress. Most studies lacked pretreatment baseline, making causality difficult. Survivorship care plans often omit sexual health screening.

Conclusions: Testicular cancer survivors experience significant psychosexual challenges, especially after chemotherapy or non-nerve-sparing RPLND. Routine sexual function assessment and fertility preservation counseling should be integrated into survivorship protocols.