OBJECTIVE: To evaluate the impact of a urological neoplasm diagnosis on male sexuality and examine patient perceptions of healthcare professionals' engagement with sexuality at diagnosis. MATERIALS AND METHODS: This study included adult men diagnosed with urological neoplasms across two urology cancer centers from October 2022 to April 2024. Exclusions applied to those with prior cancer treatment, inactive sexual lives, or histories of anxiety/depression treatment. Data were retrospectively gathered from medical records and individual interviews using a semi-structured questionnaire on male sexuality, relationship dynamics, and perceptions of physicians' approach to sexuality. Analysis was conducted in RStudio using chi-square tests. RESULTS: A cohort of 211 patients were included in this study, with an age range of 22 to 85 years (mean = 65.4). Among these patients, the diagnoses of urogenital cancer included cases of prostate (79.1%), bladder (9.9%), kidney (4.2%), testicular (3.7%), and penile (2.8%) neoplasms. Sexual activity was considered important by 90.5%, with 75.8% reporting decreased frequency post-diagnosis (99.5% were heterosexual and 72.5% were married). Anxiety or depression was reported by 46.9%, while 72% developed specific fears, primarily concerning erectile function and partner satisfaction. Only 23.2% of physicians addressed sexuality at diagnosis, with patient satisfaction significantly higher when these discussions occurred. Satisfaction levels were notably correlated with tumor site, with bladder cancer patients reporting higher satisfaction compared to those with prostate or penile cancer. CONCLUSIONS: Sexual issues extend beyond genital urological cancers, affecting patients with kidney and bladder cancers, with impacts often beginning at diagnosis. Early discussions on sexual health, combined with empathetic support, sexual education, and multidisciplinary care, are essential for the well-being of patients and their partners.