Sexual functioning after penile cancer surgery: comparison between surgical approaches in a large patient cohort

Very few studies examine sexuality after penile cancer (PeCa) surgery and/or evaluate predictors of sexual satisfaction. Since 2016, primary PeCa patients at our institute routinely received the International Index of Erectile Function (IIEF-15) questionnaire: preoperatively (baseline) and 3-, 6-, 12- and 24-months postoperatively. We included patients who were surgically treated at our institute and completed the baseline and ≥1 follow-up questionnaire. Sexually active patients were divided into groups: wide local excision (WLE), glansectomy, partial penectomy and total penectomy with perineal urethrostomy. Linear mixed effects models were used for longitudinal analyses with repeated measures to examine predictors of overall sexual satisfaction. 647 patients with (suspected) PeCa were evaluated and received questionnaires. 543 (83.9%) returned the questionnaires. 242 were suitable for analysis. Preoperatively, only 55/242 (22.7%) were sexually active. Postoperatively, the number of sexually active patients increased for WLE (30.8% at baseline, 43.5% at two-year follow-up) and glansectomy (35.0% to 40.0%, both p < 0.001). Sexual satisfaction was below the level of healthy men in all patients, both pre- and postoperatively. Longer follow-up time, younger age, and penile-sparing surgeries were predictors for better sexual satisfaction. Our findings underscore the importance of considering penile-sparing surgical approaches in the treatment of PeCa when oncologically feasible. The significant improvements in sexual activity and sexual satisfaction following WLE and glansectomy support this approach. However, the overall sexual satisfaction after all PeCa surgery remains below the level of the healthy men, both pre- and post-operative, emphasizing the importance of guidance throughout the treatment trajectory.