Oncosexology: A Narrative Review on Sexual Health and Quality of Life in Cancer Patients

ABSTRACT

Cancer remains a major global public health problem. A key aspect of cancer care among survivors is sexual health. Cancer patients experience a range of sexual dysfunctions, including erectile dysfunction, vaginal dryness, dyspareunia, and reduced libido. Psychological symptoms such as anxiety, fatigue, and body image issues often exacerbate these problems, leading to impaired emotional and relational functioning. Despite their profound impact on quality of life, these concerns are not systematically addressed in routine cancer care. Oncosexology fits into this context, addressing the profound impact of cancer and its treatments on sexual health and intimacy.

Objectives

This narrative review provides an overview of the current evidence on sexual dysfunction in adult cancer patients, including psychosocial correlates and available interventions, to help clinicians understand the scope, challenges, and management strategies related to sexual health in oncology.

Method

The study was conducted by searching major scientific databases using search terms related to sexual health in cancer patients. Inclusion criteria were studies involving adult cancer patients, focusing on sexual health outcomes, therapeutic interventions, or care models, and published in peer‐reviewed journals. Articles were selected based on the relevance of their findings and the quality of their presentation.

Results

Data published in the literature show that sexual dysfunctions are common in cancer populations and often co‐occur with psychological problems such as anxiety, fatigue, and altered body image. Interventions range from pharmacological treatments to psychosocial and psychosexual counseling and multidisciplinary care models. The results also highlight that, despite the difficulties patients and healthcare providers encounter in communicating about these topics, multidisciplinary interventions can help reduce these dysfunctions.

Conclusions

Integrating sexual health into cancer care is essential to promoting overall well‐being and supporting long‐term survival. Further high‐quality, cancer‐specific research is needed to support evidence‐based, patient‐centered interventions across diverse cancer populations.

1. Introduction

The global incidence of cancer, according to data shown by the International Agency for Research on Cancer (IARC), has increased from approximately 14.1 million new cases in 2012 to approximately 20.0 million in 2022, with 9.7 million cancer deaths. About one in five men or women develop cancer in their lifetime, and about one in nine men and one in twelve women die from it [1]. Incidence and mortality data highlight that cancer remains one of the most important challenges for public health globally and has a significant impact on healthcare systems and populations [2, 3, 4]. Advances in early diagnosis, multimodal treatments, and supportive care have significantly improved survival rates, leading to a growing population of cancer survivors [5].

According to the National Cancer Institute, a person is considered a cancer survivor from the moment of diagnosis until the end of life [6]. However, the experience of illness and cancer treatments is frequently associated with persistent physical and psychosocial morbidity, negatively impacting quality of life, personal identity, intimate relationships, and sexual health [7].

Sexual dysfunction is frequently reported across multiple cancer types, particularly due to chemotherapy, pelvic radiotherapy, and hormonal therapies, and commonly manifests as erectile dysfunction, vaginal dryness, dyspareunia, and reduced sexual desire, significantly affecting patients' quality of life, relationships, and mental well‐being [8, 9, 10, 11]. In this context, sexual health represents a fundamental but frequently overlooked component of comprehensive cancer care [12, 13]. The increasing attention to sexual quality of life as a relevant outcome in survival has led to the development of oncosexology, an interdisciplinary field that integrates oncology, psychology, sexology, and rehabilitation, addressing sexual disorders related to the disease and treatments, body image alterations, couple dynamics, and sexual rehabilitation pathways [14, 15, 16].

Despite their high prevalence, sexual health problems are often not addressed in standard cancer care, highlighting the need for structured and specialized support services. In 2024, American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) updated their guidelines to support healthcare professionals in assessing and managing sexual health and improving the quality of life for cancer survivors, promoting a multidisciplinary, evidence‐based approach centered on doctor‐patient communication [17, 18]. Tables 1 and 2 show and summarize the main guidelines, strategies, and multidisciplinary treatments to be adopted to improve the sexual health of patients.

TABLE 1.

Clinical practice guidelines in oncology for survival of female patients (adapted by [18]).

Female with concerns/issues regarding sexual health
Symptoms	Treatment options	Follow‐up
Symptoms of menopause (SHRS‐1), vaginal dryness, or other issues related to vaginal health (e.g., discomfort, discharge pain)	SHRS‐5	Concerns regarding sexual function improved or resolved Ongoing concerns regarding sexual function	Re‐evaluate at regular intervals Refer to appropriate healthcare provider for further evaluation, workup, and/or treatment: Primary care Gynecology Psychology (may include couples counseling) Sexual health specialist Sex therapist, if available
Low or lack of desire, libido, or intimacy	Refer to appropriate healthcare provider to address contributing psychosocial problems Discussion of available drugs (e.g., androgens, bupropion, buspirone, flibanserin, bremelanotide)
Symptoms of pain with sexual activity	Topical vaginal therapies (SHRS‐5) (OTC or prescription) Vaginal dilators Ospemifene DHEA Pelvic physical therapy Topical anesthetics (OTC or prescription)
Problems with orgasm (e.g., reduced intensity, difficulty achieving orgasm)	Discussion of options including vibrator or clitoral stimulatory device with referral to appropriate specialist Pelvic physical therapy
Multiple issues identified
Global symptoms of distress, anxiety (generalized or about sex) depression or other psychological concerns	SANXDE‐1

Abbreviations: DHEA, Deidroepiandrosterone; OTC, Over The Counter; SANXDE‐1, Screening for Anxiety, Distress and Depression – 1; SHRS, Sexual Health Resource Sheet.

TABLE 2.

Clinical practice guidelines in oncology for survival of male patients (adapted from [18]).

Male with concerns/issues regarding sexual health
Symptoms	Treatment options	Follow‐up
Erectile dysfunction	Oral PDE5 inhibitors as needed, if not contraindicated Testosterone therapy may be indicated Daily low‐dose oral PDE5 inhibitors, if not contraindicated HL‐1 modification (e.g., increased physical activity, smoking cessation, reduction of alcohol consumption, weight loss if obese) Pelvic physical therapy	Concerns regarding sexual function improved or resolved Ongoing concerns regarding sexual function	Re‐evaluate at regular intervals Refer to appropriate healthcare provider for further evaluation, workup, and/or treatment: Primary care Urology Psychology (may include couples counseling) Sexual health specialist Sex therapist, if available
Low or lack of desire, libido or intimacy	Refer to appropriate healthcare provider Testosterone therapy may be indicated
Problems with ejaculation (premature, absent, delayed, or climacturia)	Testosterone therapy may be indicated Psychological evaluation ○ SSRIs (e.g., paroxetine, sertraline, citalopram, fluoxetine) dosed daily ○ Clomipramine dosed on demand Pelvic physical therapy For climacturia: Empty bladder prior to sex, pelvic physical therapy, or use of condoms to catch urine
Problems with orgasm (e.g., less intensity, difficulty achieving pain)	Testosterone therapy may be indicated Vibratory therapy PDE5 inhibitors if not contraindicated Cabergoline Pelvic physical therapy
Multiple issues identified
Global symptoms of distress, anxiety (generalized or about sex) depression or other psychological concerns	SANXDE‐1

Abbreviations: HL‐1, Healthy Lifestyle – Level 1; PDE5, Phosphodiesterase type 5; SANXDE‐1, Screening for Anxiety, Distress and Depression; SSRIs, Selective Serotonin Reuptake Inhibitors.

This overview of the latest years of oncosexology aims to provide a critical narrative review of the available evidence on cancer‐related sexual dysfunctions, highlighting their prevalence, biological and psychosocial determinants, impact on quality of life, and the main assessment and clinical management strategies. The study aims to highlight current gaps in patient interest in and management of sexual health and to improve sexual health care in oncology, addressing an area that is still largely underestimated in clinical practice. Studies related to the main types of male and female cancers linked to the sexual sphere will be considered, with a focus on current physical, sexological, psychological, and therapeutic issues.

2. Methods

A narrative review of the literature was conducted with the aim of providing a critical and integrated synthesis of the available evidence on the effects of cancer and cancer therapies on the sexual health and quality of life of cancer patients. The choice of a narrative approach was decisive and motivated by the multidimensional and interdisciplinary nature of oncosexology, which encompasses biological, psychological, relational, rehabilitative, and organizational aspects. The published studies were searched in specialized databases such as PubMed, MedLine, Scopus, Science Direct, and Google Scholar using the following keywords: “oncosexology,” “sexual dysfunction in oncology,” “sexual health in cancer patients,” “cancer survival,” “sexual well‐being in cancer patients,” and “oncosexology interventions.” Studies published in English up to July 2025 were included, and articles were selected based on clinical relevance, relevance to the review objectives, and scientific quality, prioritizing studies published in peer‐reviewed journals with recognized impact in the fields of oncology and psychosocial aspects. The initial screening of titles and abstracts was followed by a full‐text analysis of the articles deemed eligible. Exclusion criteria included publication in languages other than English, lack of access to the full text, and poor scientific or clinical relevance.

3. Results and Discussion

3.1. Late Effects of Cancer Treatments on Sexual Health

Oncological treatments can have a wide range of long‐term physical and psychological effects that significantly impact sexual health and intimate relationships. These effects may arise from surgery, radiotherapy, systemic therapies, or hormonal treatments and often occur in various types of cancer [19, 20]. Surgical procedures can alter body image, anatomical structures, and nerve integrity, potentially causing pain, erectile dysfunction, vaginal shortening, or reduced sexual sensitivity, depending on the anatomical site involved [21, 22]. Radiotherapy may contribute to tissue fibrosis, reduced lubrication, vaginal stenosis, and decreased elasticity of the genital tissues. Systemic treatments such as chemotherapy often induce alopecia, weight gain, fatigue, hormonal changes, early menopause, and decreased libido [23, 24, 25]. Commonly used hormonal therapies are particularly associated with sexual dysfunction, including decreased libido, erectile dysfunction, vaginal dryness, dyspareunia, and mood swings [26, 27].

In addition to physical changes, cancer treatments can affect psychological factors such as sexual identity, self‐esteem, and emotional intimacy, and may lead to anxiety, depression, and fear of recurrence, all of which contribute to sexual difficulties in cancer survivors [28, 29].

Early discussion of potential sexual side effects and timely interventions can improve patient outcomes and quality of life.

3.2. Sexual Health in Gynecological Cancer Patients

Gynecological cancers, including cervical, vaginal, ovarian, and uterine cancers, are a significant threat to women worldwide, accounting for nearly 40% of all newly diagnosed cancers and over 30% of all cancer deaths in women. These tumors are a serious public health issue with 3.6 million new cases and 1.3 million deaths reported globally [30, 31]. The high mortality rate from gynecological cancers indicates the need to improve public health policies to prevent and diagnose these diseases [32, 33, 34]. Several studies have shown that nearly 90% of gynecological cancer survivors report significant long‐term side effects, and one of the most distressing symptoms of their sickness is sexual dysfunction [35, 36]. Evidence suggests that ovarian cancer patients carrying germline BRCA1/2 mutations have a higher risk of psychosexual morbidity compared with gBRCA‐wt patients, likely due to early surgical menopause and an increased risk of breast cancer [37]. The difficulty in communicating these issues to one's partner and healthcare providers can further amplify the distress. As reported by a recent study by de Souza et al., some patients expressed fear of partners' rejection, while others reported feeling embarrassed about their bodies, leading them to avoid physical and visual intimacy [38].

Considering this evidence, a structured assessment of sexual health is fundamental. Screening tools allow for the early identification of physical, emotional, and relational issues and facilitate doctor‐patient communication on topics that are often overlooked [39, 40]. More than 70% of cancer patients expressed a preference for using sexual health questionnaires followed by a discussion with their clinician [41].

Without adequate assessment, patients may mistakenly believe there are no treatment options, contributing to the chronicity of symptoms [42]. Several screening tools are available to assess sexual health. The European Organization for Research and Treatment of Cancer (EORTC) has developed three different questionnaires to assess sexual health in gynecological cancer patients, including the EORTC QLQ‐CX‐24, the EORTC QLQ‐EN‐24, and the EORTC QLQ‐OV28 questionnaire [43, 44]. Other relevant questionnaires include the Sexual Function and Vaginal Changes Questionnaire (SVQ) and the Female Sexual Function Index (FSFI) [45, 46]. However, these tools remain underutilized, largely due to clinician discomfort, insufficient training, and the absence of standardized guidelines for their use [47, 48, 49]. Systematic integration of these tools into routine oncological practice appears essential to improve the diagnosis of sexual dysfunction and enhance survivors' quality of life.

3.3. Sexual Health in Breast Cancer Patients

Breast cancer (BC) is one of the most common malignant tumors among women globally, with the number of cases accounting for more than 1/3 of all female cancer patients, with a steadily increasing incidence rate [50]. Despite the great progress made in BC treatment, biological characteristics such as immune evasion, easy recurrence, and drug resistance are still the main reasons limiting the survival of patients [51, 52]. However, the 5‐year survival rate has increased to 90%, and the age‐standardized overall mortality rate has decreased to 16.3 per 100,000 inhabitants largely due to advances in screening programs and therapeutic strategies [53, 54].

Increased survival makes sexual health a central aspect of patients' quality of life [55, 56, 57]. The French longitudinal study VICAN (VIe après le CANcer) highlighted how age, chemotherapy, and total mastectomy are associated with reduced sexual desire and frequency in more than 60% of patients, while only 15% discussed these issues with the healthcare team [58].

The impact of breast surgery on sexual health has been further confirmed by studies that have shown a higher prevalence of sexual dysfunction and reduced self‐esteem in women who have undergone mastectomy compared to healthy women or patients treated with breast‐conserving surgery, both in the short and medium term [59, 60, 61]. Difficulties with sexual intimacy are frequently exacerbated by relational and psychological factors [60, 62]. Overall, studies suggest the need to systematically integrate sexual health assessment and management into breast cancer care pathways, through structured communication strategies between patients and the medical team and targeted support interventions, in order to improve survivors' quality of life.

3.4. Sexual Health in Prostate Cancer Patients

Prostate cancer (PCa) affects approximately 10 million men worldwide, of whom approximately 700,000 have a metastatic form but with a 5‐year overall survival rate of 98% [63]. Due to its high incidence, it is considered the second most diagnosed solid tumor in men, after lung cancer, affecting almost six out of ten men over 65 [64, 65, 66].

The main treatments for PCa, including radical prostatectomy, external beam radiation therapy (EBRT), and low‐dose‐rate brachytherapy (LDR‐B), are associated with a significant impact on sexual health [67]. Beji et al. reported erectile dysfunction in 70.8% of patients treated with LDR‐B, often accompanied by anejaculation and reduced orgasm intensity, resulting in a worsening of quality of life [68]. Furthermore, population data indicate that over 80% of men report sexual problems after diagnosis, but more than 50% do not receive adequate therapeutic support, highlighting a significant care gap [69].

In addition to the physical effects, PCa and its treatments have a substantial impact on psychological and relational well‐being. Partners often become an essential source of support, yet relationship conflicts may arise due to communication difficulties and a lack of preparation for these challenges [70, 71, 72, 73]. Qualitative studies have also highlighted unmet informational and psychosocial needs, particularly in patients undergoing androgen deprivation therapy, with repercussions on personal identity and couple dynamics [74, 75]. Overall, PCa has a significant impact not only on the patient but on the entire family unit, making open communication and a couple‐centered approach essential for fostering adaptation and mutual support [76]. After treatment, managing intimacy and sexuality remains a complex challenge, with lasting effects on intimate relationships [77, 78]. The integration of targeted interventions and structured clinical support therefore appears crucial for improving the quality of life of patients and partners in the survivorship phase [79, 80, 81].

3.5. Sexual Health in Penile Cancer Patients

The incidence of penile cancer (PC), a rare malignancy, ranges from 0.94 per 100,000 males in Europe to 2% per 100,000 men in Southern America, Asia, and Africa [82, 83, 84, 85]. Currently, in localized PC, conservative surgical treatments are available, including topical therapy, laser ablation, wide local excision, and glansectomy, while in more advanced forms, partial or total penectomy remains the standard treatment [82, 86].

Impairment of sexual function is highly dependent on the extent of surgical treatment and is most pronounced after total penectomy [87]. Observational studies have reported a substantial reduction in sexual function after both total penectomy and, to a lesser extent, after partial penectomy or extensive excisions, confirming the high functional burden of this condition [88, 89]. These outcomes are further amplified by the symbolic significance attributed to the penis in relation to male identity and virility [90, 91].

These dysfunctions also cause alterations in relationships, fear of intimacy, and loss of communication with the partner [87, 92]. For these reasons, integrated support interventions, including sex counseling, psychological therapy, and the use of sexual assistive devices, can facilitate adaptation and the maintenance of intimacy [93, 94]. Specifically, in patients who have undergone total penectomy, recognizing sexual disability and reprocessing body image are central elements of a multidisciplinary oncosexological approach [95, 96].

3.6. Sexual Health in Testicular Cancer Patients

Testicular cancer is the most prevalent solid tumor afflicting men aged 15–44 years, but it also makes up 1%–2% of all male tumors and is the 20th most common type of cancer in males worldwide. In 2020, 74,458 new cases were diagnosed and over 9300 deaths occurred despite the high recovery rates achieved thanks to therapeutic advancements [97, 98, 99].

Diagnosis and treatments, particularly total or partial orchiectomy, chemotherapy, and radiotherapy, can have a significant impact on the sexual, reproductive, and psychological health of survivors [100, 101, 102]. In this context, testicular prostheses can help preserve self‐esteem and the perception of masculinity [103, 104]. Numerous studies have documented a high prevalence of fear of recurrence, often associated with a perception of compromised masculinity and sexual function disorders, including alterations in orgasm, ejaculation, and azoospermia [105, 106, 107].

Therefore, an integrated multidisciplinary approach, including psychological and sexological support in oncological follow‐up, is essential to improve patients' long‐term quality of life [108].

3.7. Sexual Health in Bladder Cancer Patients

Bladder cancer is one of the most common malignancies worldwide and is the tenth leading cause of cancer mortality, exhibiting a marked gender disparity, being the fourth most common cancer in men and the tenth in women [109]. Currently, treatment options include intravesical therapies, radical surgery, radiotherapy, and systemic therapies. Transurethral resection of bladder tumor is the standard treatment for non‐muscle‐invasive forms, while cystectomy is indicated for advanced forms [110, 111]. Similar to other urological cancers, treatments for bladder cancer have a significant impact on sexual health and quality of life [112, 113], while conservation strategies are associated with a better body image and higher levels of sexual satisfaction [114].

However, the available evidence is limited by high heterogeneity in assessment tools and by the insufficient integration of psychological and relational outcomes, similar to what has been observed in other urological cancers [115]. Overall, these data support the need for a multidisciplinary oncosexological approach in bladder cancer as well, which integrates the assessment of sexual function, psychological well‐being, and couple dynamics throughout the entire treatment pathway.

3.8. Sexual Health in Colorectal Cancer Patients

Colorectal cancer (CRC) is the second most prevalent cause of mortality from cancer worldwide, accounting for more than 900,000 deaths in the year 2020 [116]. The incidence increases significantly with age, with most diagnoses occurring after 55 years old and a higher frequency in men than in women, especially after the age of 50 [117, 118]. The conventional treatment for CRC consists of a partial or total colectomy, stoma surgery, and, for locally advanced forms, it may be preceded by radio‐chemotherapy [119, 120]. CRC and its treatments significantly compromise sexual and relational health. Sexual dysfunction is reported in 24%–68% of patients, with a particularly high prevalence in patients with early‐onset CRC [121, 122, 123].

The presence of a stoma and body image alterations amplify sexual and relationship distress, and despite the high psychological and relational impact, there is a lack of specific psychological interventions for this population [124, 125, 126]. Recent evidence suggests that integrated and couple‐oriented approaches, including digital strategies, represent promising options for improving intimacy and quality of life in CRC survivors [127].

3.9. Therapeutic Interventions and Treatments to Improve Sexual Health in Oncosexology

Sexual health issues in cancer patients after diagnosis and treatment often remain underdiagnosed and undertreated. Oncosexology aims to reduce the physical, psychological, and social impact of cancer on sexuality, and numerous studies support the effectiveness of multidisciplinary approaches, psychosexual counseling, and innovative technological solutions in improving clinical outcomes and quality of life [128].

In this context, the need for structured and integrated sexual health programs within oncology care pathways becomes evident. Studies by Walker et al. have shown that specialized clinics allow for a systematic approach to issues often overlooked during oncological follow‐up, highlighting the feasibility, sustainability, and effectiveness of dedicated organizational models [129, 130]. The pilot project Oncology and Sexuality, Intimacy and Survival (OASIS) provided integrated biopsychosocial support for complex disorders such as vulvovaginal atrophy, dyspareunia, erectile dysfunction, and reduced desire, showing a significant reduction in sexual distress at follow‐up [130].

Another practical approach involves various psychological, psychoeducational, and training interventions, including sexual counseling, psychoeducational programs and sex education, mindfulness‐based psychoeducational strategies, cognitive‐behavioral therapy (CBT), and couple‐based interventions [131]. Although it takes time, sex therapy is one of the most important interventions to consider to help patients resolve or better tolerate sexual dysfunctions and to provide the fundamental principles of sexual health. Psychoeducational interventions and training courses to learn how to manage sexual problems are recommended for all cancer patients. Indeed, mindfulness‐based cognitive‐behavioral therapy has been shown to be effective in treating sexual dysfunction among cancer survivors [132, 133]. Psychosocial support is particularly relevant for young survivors of gynecological cancers, helping to reduce anxiety, psychosexual distress, body image issues, and infertility‐related distress [131, 134]. Communication skills training for partners is also recognized as a widely used therapeutic strategy to improve couple communication and foster new forms of intimacy, promoting greater understanding, emotional closeness, and better adaptation to the illness [127]. Indeed, since cancer is also a “relational illness”, couple‐based rehabilitation should be an important consideration [135]. As demonstrated by Li et al., couple‐based interventions show positive, mild‐to‐moderate effects on the physical health of cancer patients [136]. These interventions often integrate psychoeducation, skills training, and therapeutic counseling to improve communication, coping strategies, and mutual understanding, effectively addressing both the physical and emotional dimensions of sexuality [137, 138].

Psychosexual rehabilitation, supported by specialized physiotherapists and nurses, includes pelvic floor physiotherapy techniques, biofeedback, relaxation, and manual therapies, with documented benefits in reducing pain and improving sexual function [139, 140]. However, while these programs offer significant relational benefits, their impact on sexual function and self‐concept remains limited, particularly in male patients. This limitation is often attributed to the insufficient duration of the intervention or the lack of long‐term follow‐up. Among female patients, the results are inconsistent, likely due to the heterogeneity of the cancer types and treatment modalities studied [136].

For these reasons, it is recommended to supplement these interventions with pharmacological therapies aimed at improving and resolving post‐treatment sexual dysfunction. In women, cancer treatments can induce various systemic symptoms [141]. It has been shown that treating the genitourinary symptoms of early menopause with non‐hormonal vaginal moisturizers and lubricants leads to an approximate 60% reduction in vaginal dryness and dyspareunia [142]. Hormone therapies are considered relatively safe for some patients, including those being treated with tamoxifen, provided a careful risk–benefit assessment is conducted [143, 144]. The use of low‐dose vaginal estrogens reduces the symptoms of vaginal atrophy with a minimal increase in serum estrogen levels [145]. Supporting this, a study compared the use of testosterone with the estradiol vaginal ring in two groups of postmenopausal patients with hormone receptor‐positive breast cancer receiving aromatase inhibitors. The results indicate improvements in vaginal atrophy, sexual desire, and sexual function in both groups [144, 146, 147].

In men, it has been shown that type 5 phosphodiesterase inhibitors (PDE5‐Is) improve blood flow, promoting erection and reducing erectile dysfunction [148, 149, 150]. However, not all patients respond adequately to this therapy, especially in cases involving significant nerve damage, such as after prostatectomy [151, 152]. Alternatively or in combination, vacuum erection devices (VEDs) can be used to induce an artificial erection [153]. These devices have also proven effective in penile rehabilitation, contributing to the recovery of spontaneous erectile function [154, 155]. A more invasive, but often effective, pharmacological option is intracavernosal injections (ICIs) of vasoactive drugs such as papaverine and phentolamine [156]. Numerous studies in the literature have highlighted that early use of these injections can promote the recovery of spontaneous functional erections, especially in patients who have undergone radical retropubic prostatectomy [157, 158]. When conservative therapies are ineffective, penile prosthesis implantation may be considered. Although this is the most invasive option and carries surgical risks (e.g., infection), it offers high satisfaction rates—up to 90%—due to improvements in erectile function, especially when other treatments have failed [159, 160, 161]. In patients with hypogonadism, testosterone replacement therapy can improve libido and sexual function, with several available modes of administration [162, 163, 164]. Ejaculatory disorders require a targeted approach, including pharmacological therapies such as alpha‐1 adrenergic agonists (midodrine or pseudoephedrine) or fertility preservation techniques such as electroejaculation or surgical sperm extraction [165].

Overall, the management of cancer‐related sexual dysfunction requires a multidisciplinary and personalized approach that integrates psychological, rehabilitative, and pharmacological interventions to significantly improve the sexual function and quality of life of cancer patients. Table 3 summarizes the possible therapeutic approaches and treatments that can be implemented to improve the sexual health of cancer patients.

TABLE 3.

Clinical protocols and therapeutic approaches aimed at optimizing sexual health in the field of oncosexology.

Intervention category	Type of intervention	Clinical target	Main benefits	Limitations/notes	References
Organizational and multidisciplinary approaches	Dedicated sexuality clinics and tiered care models (e.g., OASIS clinic)	Patients with complex post‐treatment sexual health concerns	Reduction in sexual distress; integrated biopsychosocial care	Requires dedicated resources and long‐term sustainability	[128, 129, 130]
Psychological and psychoeducational interventions	Sexual counseling, psychoeducation, sex education programs	All cancer patients	Improved awareness, coping strategies, and sexual quality of life	Time‐consuming; requires patient engagement	[131, 134]
	Cognitive behavioral therapy (CBT) and mindfulness‐based CBT	Cancer survivors with sexual dysfunction	Improved sexual function and reduced psychological distress	Stronger evidence in controlled settings	[132, 133]
	Couple‐based interventions and communication skills training	Patients in stable relationships	Improved intimacy, communication, and disease adaptation	Mild‐to‐moderate effects on physical outcomes	[127, 135, 136, 137, 138]
Psychosexual rehabilitation	Pelvic floor physiotherapy, biofeedback, relaxation exercises, trigger point therapy	Dyspareunia, sexual pain, pelvic floor dysfunction	Reduced pain and improved sexual function	Short intervention duration and limited follow‐up; heterogeneous outcomes	[136, 139, 140]
Pharmacological therapies—Women	Non‐hormonal vaginal moisturizers and lubricants	GSM, vaginal dryness, dyspareunia	Up to 60% reduction in symptoms	Requires regular application	[141, 142]
	Low‐dose vaginal estrogen therapy	Post‐treatment vaginal atrophy	Symptom relief with minimal systemic absorption	Individual risk–benefit assessment required	[143, 144, 145]
	Vaginal testosterone therapy	Selected patients with HR+ breast cancer	Improved vaginal atrophy, sexual interest, and function	Hormonal monitoring required	[144, 146, 147]
Pharmacological therapies—Men	Phosphodiesterase type 5 inhibitors (PDE5‐Is)	Post‐treatment erectile dysfunction	Improved penile blood flow and erectile function	Reduced efficacy in cases of nerve damage	[148, 149, 150, 151, 152]
	Vacuum erection devices (VEDs)	Penile rehabilitation	Recovery of spontaneous erectile function	Variable patient acceptability	[153, 154, 155]
	Intracavernosal injections (ICIs)	Refractory erectile dysfunction	High efficacy in erectile recovery	Invasive; requires patient training	[156, 157, 158]
	Penile prosthesis implantation	Severe refractory erectile dysfunction	High patient satisfaction rates	Invasive surgical procedure	[159, 160, 161]
	Testosterone replacement therapy (TRT)	Hypogonadism and reduced libido	Improvement in sexual desire and function	Selective indication; careful monitoring required	[162, 163, 164]
Management of ejaculatory disorders	α‐adrenergic agonists, electroejaculation, surgical sperm retrieval	Ejaculatory dysfunction and fertility preservation	Restoration of ejaculation or reproductive potential	Highly specialized interventions	[165]

Abbreviations: CBT, Cognitive Behavioral Therapy; GSM, Genitourinary Syndrome of Menopause; HR+, Hormone Receptor Positive; ICI, Intracavernosal Injection; OASIS, Oncology and Sexuality, Intimacy and Survival; PDE5‐I, Phosphodiesterase Type 5 Inhibitor; TRT, Testosterone Replacement Therapy; VED, Vacuum Erection Device.

3.10. New Approaches Based on the Use of Technology: Web‐Based Sexual Counseling

Receiving a cancer diagnosis can cause significant psychological distress, but most patients do not receive psychological support during this crucial time. Online therapies can fill this gap, helping patients overcome the numerous obstacles that prevent them from accessing in‐person support [166, 167]. The Internet is a significant tool for reaching cancer patients, as at least 70% of them use it to research their condition soon after receiving a diagnosis. Patient forums, information websites, and even therapeutic games are examples of recent methods for integrating the Internet into patient care. Online programs that use cognitive‐behavioral approaches and provide patient assistance through frequent online interactions with a healthcare provider (such as guided self‐help or therapist‐led programs) have become especially popular choices [168, 169].

Web‐based education may therefore represent a cost‐effective and time‐efficient solution, providing extensive information within a limited timeframe and without spatial constraints [170]. It has been shown that personalizing web‐based information and support interventions is more effective and leads to greater user engagement compared to standardized information. Supporting this, a study involving 109 participants evaluated a web‐based self‐management intervention designed to maximize sexual well‐being in men with prostate cancer. The data indicate that web‐based treatment can enhance self‐perception and improve the ability to manage sexual problems, thereby increasing self‐efficacy and reinforcing the belief that a fulfilling sex life is possible after therapy [171]. Moreover, a randomized, paired study conducted after treatment for localized prostate cancer compared face‐to‐face and internet‐based versions of a sexual counseling program, called Counseling About Regaining Erections and Sexual Satisfaction (CAREss), with a waitlist control group. Although both the face‐to‐face and internet‐based versions of the program produced significant improvements in men's sexual function and satisfaction, in contrast to the outcomes observed during the 3‐month waiting period. The internet‐based version of CAREss has the potential to be more cost‐effective and accessible than traditional sex therapy. However, a limitation of this type of intervention is the high dropout rate [172]. Additionally, Web‐based Sexual Health Improvement Programs (WSHEPs) offer the opportunity to address sexual issues that couples often experience privately and might be reluctant to discuss openly. These programs allow couples to access valuable information at their convenience, ensuring an appropriate time and setting for interaction [173]. A further study presented a WSHEP intervention based on the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, addressing various aspects of sexual health, including desire, arousal, lubrication, orgasm, satisfaction, and pain, while offering the convenience of web accessibility. The study highlighted improvements in sexual function for patients with gynecological cancers and an increase in marital intimacy among their husbands [174].

Based on these data, it can be stated that web‐based interventions are feasible and have positive effects on both cancer patients and their partners in terms of sexual well‐being, physical, psychological, and social functioning. Table 4 summarizes and outlines the new approaches and strategies for web‐based sexual counseling for cancer patients.

TABLE 4.

Web‐based and digital interventions to improve sexual health and psychological well‐being in cancer patients.

Intervention category	Type of intervention	Target population	Main outcomes	Limitations/Notes	References
Online psychological support	Web‐based psychological therapies and online counseling	Newly diagnosed cancer patients	Reduction of psychological distress; improved access to care	Not all patients receive or complete support	[166, 167]
Digital patient engagement tools	Patient forums, informational websites, therapeutic games	Cancer patients seeking disease‐ and treatment‐related information	Increased patient engagement and health literacy	Variable quality and scientific reliability	[166, 167]
Web‐based CBT programs	Guided self‐help and therapist‐led online CBT interventions	Cancer patients with psychosexual distress	Improved coping skills and psychological well‐being	Requires adherence and regular interaction	[168, 169]
Web‐based educational interventions	Personalized online education and support programs	Cancer patients and survivors	Cost‐effective, time‐efficient information delivery; increased engagement	Effectiveness depends on personalization	[170]
Self‐management digital interventions	Web‐based sexual self‐management programs	Men with prostate cancer	Improved self‐efficacy, sexual self‐perception, and symptom management	Limited sample size	[171]
Online sexual counseling	Internet‐based vs. face‐to‐face CAREss program	Men treated for localized prostate cancer	Comparable improvements in sexual function and satisfaction	High dropout rates in online format	[172]
Couple‐focused web‐based programs	Web‐based Sexual Health Improvement Programs (WSHEPs)	Cancer patients and partners	Improved sexual communication and intimacy	Requires partner involvement	[173]
Structured digital psychosexual models	WSHEPs based on the PLISSIT model	Patients with gynecological cancers and their partners	Improved sexual function and marital intimacy	Limited long‐term follow‐up	[174]

Abbreviations: CAREss, Counseling About Regaining Erections and Sexual Satisfaction; CBT, Cognitive Behavioral Therapy; PLISSIT, Permission, Limited Information, Specific Suggestions, Intensive Therapy; WSHEP, Web‐based Sexual Health Improvement Program.

4. Conclusions

Although the effects of cancer and its therapies on sexual health are widely recognized, sexual well‐being is still severely neglected in cancer care, with significant unmet needs found across the patient population. Patients often feel uncomfortable discussing sexual health due to embarrassment, sociocultural stigmas, or a focus on survival rather than quality of life. Social taboos, inadequate provider training, and assumptions about patients' priorities further hinder effective communication about sexual health. Although interventions are needed, only a minority of patients seek help, often due to inadequate communication from healthcare providers or a perceived lack of legitimacy in addressing sexual health concerns within oncology care. At the same time, healthcare providers often lack the necessary training, time, and confidence to address these concerns effectively, further limiting access to necessary care.

For these reasons, oncosexology represents an important aspect of comprehensive cancer care. It addresses the profound impact of cancer and its treatments on sexual health, psychological well‐being, and intimate relationships, offering a multidisciplinary framework that integrates medical, psychological, rehabilitative, and relational interventions tailored to the specific needs of different cancer populations. Evidence summarized in this review supports the effectiveness of combined approaches, including psychosexual counseling, pelvic rehabilitation, pharmacological treatments, couple‐based interventions, and emerging digital health strategies, in improving sexual function, intimacy, and overall well‐being. Future research and clinical efforts should prioritize accessibility, long‐term assessment, and inclusivity to meet the diverse needs of cancer survivors. Addressing sexual health as a core dimension of survivorship care is essential for moving beyond disease‐centered models toward truly patient‐centered oncology that recognizes sexuality as a fundamental determinant of quality of life.

Author Contributions

Conceptualization, Pasquale Marino, Paola Amendola and Francesca Sanseverino; writing – original draft preparation, Pasquale Marino, Roberta Colangelo and Paola Amendola; writing – review and editing, Ilaria Bochicchio, Alessandro Rocco Lettini, Stefania Lapadula, Alda Giuliano and Martina Catalano; supervision, Francesca Sanseverino. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by Ministry of Health (ID 2792857).

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.