Testicular cancer and its impact on male sexual quality of life: a cross-sectional study

Cáncer testicular y su impacto en la calidad de vida sexual masculina: un estudio transversal

Background: This study assessed sexual quality of life and related issues among men with testicular cancer in Turkey using a standardized questionnaire, while examining differences by treatment method and cancer stage. Methods: A total of 168 men undergoing treatment at Erciyes University Urology Outpatient Clinic were included. Eligible participants were aged 18 or older, cognitively able to complete questionnaires, and either in active treatment or follow-up. Data were collected through a descriptive questionnaire, a sexual problems form, and the Sexual Quality of Life Scale-Male (SQLS-M). Descriptive statistics summarized demographics and clinical characteristics. One-way ANOVA with post-hoc tests evaluated differences in SQLS-M by treatment type and stage. Pearson correlation and independent t-tests were used to examine associations. Statistical significance was set at p < 0.05. Results: Younger age was significantly associated with higher SQLS-M scores (r = −0.16, p = 0.001). Patients with seminoma and those in Stage I reported significantly higher sexual quality of life than non-seminoma and advanced-stage patients (p < 0.05). Treatment type also had a significant effect (F = 12.09, p < 0.001); men who underwent surgery alone reported higher scores than those receiving chemotherapy, radiotherapy, or combined therapies. Post-hoc analyses confirmed surgery as the most favorable modality (p < 0.05). Conclusions: Sexual quality of life in men with testicular cancer is influenced by age, cancer type, stage, and treatment. Younger patients, those with seminoma, early-stage disease, and those treated with surgery alone reported better outcomes, while chemotherapy, radiotherapy, and combined therapies were associated with more dysfunction and lower satisfaction. These findings highlight the importance of addressing sexual health in cancer care and incorporating supportive strategies into treatment planning to preserve long-term quality of life.

Resumen

Antecedentes: Este estudio evaluó la calidad de vida sexual en hombres con cáncer testicular en Turquía mediante un cuestionario estandarizado, analizando las diferencias según tipo de tratamiento y estadio de la enfermedad. Métodos: Se incluyeron 168 pacientes atendidos en la Clínica de Urología de la Universidad de Erciyes, mayores de 18 años y capaces de responder cuestionarios, en tratamiento activo o seguimiento. Los datos se obtuvieron con un cuestionario descriptivo, un formulario de problemas sexuales y la Escala de Calidad de Vida Sexual-Masculina (SQLS-M). Se aplicaron estadísticas descriptivas, ANOVA de una vía con pruebas post-hoc, correlaciones de Pearson y pruebas t. Se consideró significativo p < 0.05. Resultados: La menor edad se asoció con mayores puntuaciones en la SQLS-M (r = −0.16, p = 0.001). Los pacientes con seminoma y en estadio I presentaron mejor calidad de vida sexual que los de no seminoma y estadios avanzados (p < 0.05). El tipo de tratamiento mostró un efecto significativo (F = 12.09, p < 0.001): quienes recibieron solo cirugía obtuvieron puntuaciones superiores frente a los tratados con quimioterapia, radioterapia o terapias combinadas. Los análisis post-hoc confirmaron la cirugía como modalidad más favorable (p < 0.05). Conclusiones: La calidad de vida sexual en el cáncer testicular se ve influida por edad, tipo y estadio tumoral, así como por el tratamiento. Los hombres jóvenes, con seminoma, en estadios iniciales y tratados únicamente con cirugía reportaron mejores resultados. En contraste, quimioterapia, radioterapia y terapias combinadas se relacionaron con mayor disfunción y menor satisfacción. Estos hallazgos resaltan la necesidad de integrar la salud sexual en la atención oncológica y de planificar estrategias de apoyo para preservar la calidad de vida a largo plazo.

Testicular cancer; Sexual problems; Sexual quality of life; Urooncology

Palabras Clave

Cáncer testicular; Problemas sexuales; Calidad de vida sexual; Urooncología

[1] Öztürk A, Ünalan D, Guleser G. Knowledge, attitude and practices of technicians working at hospitals towards testicular cancer and selfexamination of testicles in Turkey. Asian Pacific Journal of Cancer Prevention. 2014; 15: 10095–10099.

[2] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[3] Gürsoy P, Çakar B, Gökmen E, Sarsık Kumbaracı B, Semerci B, Caner A, et al. Epidemiology and overall survival characteristics of testicular cancers at Ege University Hospital. Ege Journal of Medicine. 2019; 58: 126–132. (In Turkish)

[4] Eser S, Örün H, Hamavioğlu E, Lofti F. Cancer incidence, mortality and survival in Türkiye as of 2020. Basic and Clinical Cancer Research. 2022; 14: 1–13.

[5] Khan M, Sheehan PK, Bazin A, Farooq AR, Leonard C, Aleem U, et al. Long-term side effects of testicular cancer and treatment (observational study of mortality and morbidity in testicular cancer survivors). Supportive Care in Cancer. 2025; 33: 413.

[6] Lubberts S, Groot HJ, de Wit R, Mulder S, Witjes JA, Kerst JM, et al. Cardiovascular disease in testicular cancer survivors: identification of risk factors and impact on quality of life. Journal of Clinical Oncology. 2023; 41: 3512–3522.

[7] Hu Y, Fu X, Jiang X, Jiang M, Zheng X, Lu H, et al. The experience of fertility concerns in patients with testicular cancer: a qualitative study. Supportive Care in Cancer. 2024; 32: 529.

[8] Matulewicz RS, Singla N, Pandit K, Millard F, Bagrodia A. Re: Long-term quality of life of testicular cancer survivors differs according to applied adjuvant treatment and tumour type. European Urology. 2024; 86: 591–592.

[9] Zhou Y, Shan H, Wu C, Chen H, Shen Y, Shi W, et al. The mediating effect of self-efficacy on family functioning and psychological resilience in prostate cancer patients. Frontiers in Psychology. 2024; 15: 1392167.

[10] Gercek O, Topal K, Yildiz AK, Ulusoy K, Yazar VM. The effect of diagnosis delay in testis cancer on tumor size, tumor stage and tumor markers. Actas Urológicas Españolas. 2024; 48: 356–363.

[11] Conduit C, Hutchinson AD, Leonard M, O’Haire S, Moody M, Thomas B, et al. An exploration of testicular cancer survivors’ experience of ejaculatory dysfunction following retroperitoneal lymph node dissection—a sub-study of the PREPARE clinical trial. Journal of Cancer Survivorship. 2025; 19: 558–567.

[12] Jamshidi A, Noroozi F, Bagherzadeh R, Gharibi T. Effects of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer. BMC Women’s Health. 2025; 25: 4.

[13] Kim GY, Conduit C, O’Haire S, Chong CY, Baenziger O, Lewin J, et al. Association between low total serum testosterone and body mass index in Australian survivors of testicular cancer: a retrospective analysis. Basic and Clinical Andrology. 2024; 34: 14.

[14] Ljungman L, Eriksson LE, Flynn KE, Gorman JR, Ståhl O, Weinfurt K, et al. Sexual dysfunction and reproductive concerns in young men diagnosed with testicular cancer: an observational study. The Journal of Sexual Medicine. 2019; 16: 1049–1059.

[15] Abraham L, Symonds T, Morris MF. Psychometric validation of a sexual quality of life questionnaire for use in men with premature ejaculation or erectile dysfunction. The Journal of Sexual Medicine. 2008; 5: 595–601.

[16] Kilic A, Tastan S, Ayhan H, Seven M, Tastan B. Reliability and validity of a Turkish version of the Sexual Quality of Life-Male questionnaire: a methodological study. Sexual health. 2018; 15: 413–419.

[17] Raffo M, Di Naro A, Napolitano L, Aveta A, Cilio S, Pandolfo SD, et al. Testicular cancer treatments and sexuality: a narrative review. Medicina. 2024; 60: 586.

[18] Tan JR, Goh YK, Lei CM, Shamsudin NM, Omar S, Lim MS, et al. A survey of attitude on sperm banking and barriers to its use among testicular cancer patients in a multicultural Asian population. Société Internationale d’Urologie Journal. 2024; 5: 247–255.

[19] Leeners B, Tschudin S, Wischmann T, Kalaitzopoulos DR. Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis. Human Reproduction Update. 2023; 29: 95–125.

[20] Al Hussein Al Awamlh B, Wallis CJD, Penson DF, Huang LC, Zhao Z, Conwill R, et al. Functional outcomes after localized prostate cancer treatment. JAMA. 2024; 331: 302–317.

[21] Smedsland SK, Vandraas KF, Bøhn SK, Dahl AA, Kiserud CE, Brekke M, et al. Sexual activity and functioning in long-term breast cancer survivors; exploring associated factors in a nationwide survey. Breast Cancer Research and Treatment. 2022; 193: 139–149.

[22] Zhang X, Li Y, Yan C, Ma L, Yu M, Yang Y, et al. Global trends in testicular and prostate cancer among adolescents and young adult males aged 15–49 years, 1990–2021: insights from the GBD study. Scientific Reports. 2025; 15: 23388.

[23] Anne Thamar Louis L, Fortin J, Roy CA, Brunet A, Aimé A. Body image interventions within breast cancer care: a systematic review and concept analysis. Journal of Psychosocial Oncology. 2024; 42: 427–447.

[24] Vegunta S, Kuhle CL, Vencill JA, Lucas PH, Mussallem DM. Sexual health after a breast cancer diagnosis: addressing a forgotten aspect of survivorship. Journal of Clinical Medicine. 2022; 11: 6723.

[25] Dinapoli L, Colloca G, Di Capua B, Valentini V. Psychological aspects to consider in breast cancer diagnosis and treatment. Current Oncology Reports. 2021; 23: 38.

[26] Li K, He X, Tong S, Zheng Y. Risk factors for sexual dysfunction after rectal cancer surgery in 948 consecutive patients: a prospective cohort study. European Journal of Surgical Oncology. 2021; 47: 2087–2092.

[27] Acquati C, Hendren S, Wittmann D, Reese JB, Karam E, Duby A, et al. Psychological and sexual distress in rectal cancer patients and partners. Psychooncology. 2022; 31: 920–928.

[28] Campos LS, De Nardi SP, Limberger LF, Caldas JM. Sexual function and disease progression in women with advanced cancer. Supportive Care in Cancer. 2022; 30: 5093–5098.

[29] Marcos-Delgado A, Martín-Sánchez V, Molina-Barceló A, Alonso-Molero J, Pérez-Gómez B, Pollán M, et al. Health-related quality of life in long-term colorectal cancer survivors. Healthcare. 2024; 12: 1917.

[30] Reiser E, Böttcher B, Ossig C, Schiller J, Tollinger S, Toth B. Female cancer survivors: sexual function, psychological distress, and remaining fertility. Journal of Assisted Reproduction and Genetics. 2024; 41: 1057–1065.

[31] Sun V, Grant M, Wendel CS, McMullen CK, Bulkley JE, Herrinton LJ, et al. Sexual function and health-related quality of life in long-term rectal cancer survivors. The Journal of Sexual Medicine. 2016; 13: 1071–1079.

[32] Barsky Reese J, Porter LS, Regan KR, Keefe FJ, Azad NS, Diaz LA Jr, et al. A randomized pilot trial of a telephone-based couples intervention for physical intimacy and sexual concerns in colorectal cancer. Psychooncology. 2014; 23: 1005–1013.

[33] DuHamel K, Schuler T, Nelson C, Philip E, Temple L, Schover L, et al. The sexual health of female rectal and anal cancer survivors: results of a pilot randomized psycho-educational intervention trial. Journal of Cancer Survivorship. 2016; 10: 553–563.

[34] Donovan KA, Taliaferro LA, Alvarez EM, Jacobsen PB, Roetzheim RG, Wenham RM. Sexual health in women treated for cervical cancer: characteristics and correlates. Gynecologic Oncology. 2007; 104: 428–434.

[35] Delican S, Güngörmüş Z. Sexual quality of life and sexual problems of women with gynecological cancer: evaluation according to treatment methods and cancer types. Sexuality and Disability. 2024; 42: 3–16.

[36] Membrilla-Beltran L, Cardona D, Camara-Roca L, Aparicio-Mota A, Roman P, Rueda-Ruzafa L. Impact of cervical cancer on quality of life and sexuality in female survivors. International Journal of Environmental Research and Public Health. 2023; 20: 3751.