Ces Urol 2026, 30(3):113-118 | DOI: 10.48095/cccu2026016

Sexual health and urological aspects of transition – a practical review for sexologists and urologists

Marek Broul^1–3, Aneta Hujová³, Marcela Fontana⁴

¹ Sexuologické oddělení, Krajská zdravotní, a.s. – Masarykova nemocnice v Ústí nad Labem, o.z.

² Urologické oddělení, Krajská zdravotní, a.s. – Nemocnice Litoměřice, o.z.

³ Fakulta zdravotnických studií UJEP v Ústí nad Labem

⁴ Urologická klinika 2. LF UK a FN Motol a Homolka, Praha

Care for transgender and gender-diverse individuals has expanded substantially in recent years, yet long-term sexual health, fertility counseling and urological follow-up remain less consistently addressed than diagnostic assessment, hormone therapy and surgery. This narrative review summarizes current evidence on sexual function and libido during transition, fertility preservation before treatment initiation, major urological complications of gender-affirming surgery, and principles of long-term follow-up. Current evidence indicates that sexual desire changes during hormone therapy are common but heterogeneous; testosterone is usually associated with increased sexual interest in transmasculine individuals but may also be linked to genital discomfort. After feminizing genital surgery, sexual satisfaction is often favorable, although dyspareunia and functional urinary symptoms are not uncommon. After masculinizing genital surgery, especially with urethral lengthening, strictures and fistulas remain among the main long-term complications. High-quality transgender care should therefore be assessed not only by access to transition-related treatment, but also by long-term sexual functioning, informed fertility decision-making and coordinated follow-up.

Keywords: transgender – gender incongruence – sexual health – libido – fertility – fertility preservation – vaginoplasty – phalloplasty – urethral stricture – sexology – urology

Received: April 25, 2026; Revised: June 2, 2026; Accepted: June 4, 2026; Published: September 21, 2026