Sexual dysfunction after cancer: gender differences, tumor-specific patterns, and implications for sexual medicine practice

Background: Sexual health is a central component of wellbeing, identity, and intimate relationships, yet it remains insufficiently addressed in cancer care. Cancer treatments disrupt sexual functioning through interacting physical, hormonal, psychological, and relational mechanisms, leading to persistent and often under-recognized sexual dysfunction among survivors. Aim: To synthesize current evidence on cancer-related sexual dysfunction, assessment strategies, and therapeutic interventions, with a focus on gender differences, tumor-site specificity, and implications for sexual medicine practice. Methods: This narrative review integrates evidence from population-based studies, clinical guidelines, and systematic reviews addressing sexual dysfunction across cancer types. Gender-specific patterns and biopsychosocial mechanisms were examined to inform assessment and management within sexual medicine and survivorship care. Results: Women commonly experience multidimensional and frequently "invisible" sexual difficulties, including reduced desire and arousal, orgasmic dysfunction, dyspareunia, vaginal atrophy, body image disturbance, and fertility-related distress. Men more often present with overt functional impairments, particularly erectile and ejaculatory dysfunction following prostate and other male cancer treatments. Existing assessment tools capture selected aspects of sexual function but often fail to reflect the full biopsychosocial complexity of post-cancer sexuality. Effective management requires integrated interventions combining medical and pharmacological therapies, physical rehabilitation, psychosexual and couples counseling, and structured communication models. Tailored, gender- and tumor-specific approaches embedded within multidisciplinary survivorship pathways are essential, including culturally competent care for sexual and gender minority patients. Conclusion: Sexual dysfunction is a prevalent and clinically relevant consequence of cancer. Comprehensive assessment and personalized, multidisciplinary interventions are essential components of high-quality sexual medicine care for cancer survivors.