Purpose <p>Orchiectomy, primarily performed for testicular cancer or other medical conditions, significantly affects young men’s sexual health, fertility, and psychosocial well-being. This study evaluates the impact of orchiectomy on genital self-image (GSI), erectile dysfunction (ED), premature ejaculation (PE), and sexual satisfaction compared to a control group.</p> Methods <p>A cohort of 240 male patients aged 18–60 who underwent orchiectomy between January 2010 and August 2024 at two tertiary hospitals was compared with 240 age-matched controls. Participants completed validated Turkish questionnaires, including the Male Genital Self-Image Scale (MGSIS), Arabic Index of Premature Ejaculation (AIPE), International Index of Erectile Function (IIEF-5), and Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Statistical analysis included Mann-Whitney U tests, Pearson’s chi-squared tests, Spearman’s correlations, and Ordinary Least Squares regression.</p> Results <p>The orchiectomy group showed significantly lower MGSIS, AIPE, and IIEF-5 scores (<i>p</i> &lt; 0.05), indicating poorer GSI, increased PE, and higher ED prevalence compared to controls. GRISS avoidance and dissatisfaction subscale scores were elevated in the orchiectomy group (<i>p</i> = 0.001). Positive correlations were observed between GSI, erectile function, and ejaculatory control, while GSI negatively correlated with sexual dissatisfaction.</p> Conclusion <p>Orchiectomy is associated with diminished genital self-image, increased sexual dysfunction, and greater sexual dissatisfaction.</p>