Sex differences in cancer survival are well-established but understudied in oropharyngeal squamous cell carcinoma (OPSCC). We evaluated the impact of sex on OPSCC survival with emphasis on geographic variation. A systematic review through June 2025 identified 84 studies (N = 451,136) from the United States ( n = 47) and non-United States cohorts ( n = 37). Meta-analyses assessed hazard ratios, proportions, and means. Most patients were male (80.8%; mean age 59.9 years). HPV-positive OPSCC was more prevalent in the US (73.8%) than non-US countries (44.0%, P < 0.0001). US males had improved overall (HR = 1.13 [1.07–1.19]) and cause-specific survival (HR = 1.11 [1.01–1.21]) than females. Non-US females had better OS (HR = 0.86 [0.77–0.95]) and CSS (HR = 0.63 [0.43–0.92]) than males. No significant differences were observed in other survival measures. Sex appears to influence OPSCC survival, with differing trends between US and non-US populations. These geographic differences likely reflect differences in HPV status. Further research stratified by sex and HPV status is needed to clarify these relationships and guide tailored interventions.