Male Sexual Dysfunction Common After Hernia Repair

Many men experience sexual dysfunction or pain during sexual activity after inguinal hernia surgery, claims a new study.

Researchers at Penn State College of Medicine (PSU; Hershey, PA, USA) conducted a systematic review and meta-analysis of studies to explore the rate of sexual dysfunction or pain during sexual activity following surgical and anesthesia methods for treating inguinal hernia. Definitions of sexual dysfunction or pain during sexual activity focused on completion of intercourse for the former, and pain with erection/ejaculation for the latter. In all, 4,884 patients from 12 different studies were identified; median age at the time of surgical repair was 52.3 years.

The results revealed that the overall incidence of new-onset, post-operative sexual dysfunction was 5.3% and of pain during sexual activity affected nine percent of the patients. Rates of sexual dysfunction associated with minimally invasive surgical (MIS) were 7.8%, and 3.7% for open repair. The associated rates of pain during sexual activity were 7.4% for MIS and 12.5% for open repair. Among men who had open procedures, 1.9% of those who had general anesthesia developed sexual dysfunction, compared with 6.2% who had local anesthesia. The study was published on November 13, 2019, in Journal of the American College of Surgeons.

“It's possible that some patients had sexual dysfunction or painful sexual activity as a result of the hernia and not the repair. Structures that are important in sexual function, such as the vas deferens or the blood vessels and nerves that supply the testicle may become tethered or trapped in the scar that forms around the repair,” said senior author David Soybel, MD. “In both open and laparoscopic repairs, nerves that provide sensation to the skin of the groin, scrotum and penis are in the operative field, and may be at risk for trapping or interruption, which can interfere with sensations that are part of the experience of sexual intercourse.”

A majority of hernia procedures involve some form of prosthesis, such as surgical meshes or plugs. These systems are often fixed in place using sutures, tacks, or other methods that hold the devices firmly in place. The fixation is thought to be one of the reasons for the syndrome of postoperative chronic hernia pain. Studies have shown that flat meshes shrink by up to 30%, while plug shrinkage can be as high as 70%. In both cases the implant can pull on the fixation, become rigid or feel like a hard, fibrotic foreign body.

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