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 The authors analyzed data from 12 previous studies with a total of
4,884 patients. They focused on men who had what's known as an
inguinal hernia, when soft tissue in the intestine bulges through
the abdominal wall into the groin.
Overall, 5.3% of men developed sexual dysfunction after surgeries to
repair inguinal hernias and 9% of men developed pain during sexual
activity.
"At least temporary sexual dysfunction and pain with sexual activity
are not very common but also not very rare as outcomes of inguinal
hernia repair in men," said Dr. David Soybel of the Pennsylvania
State University College of Medicine in Hershey, the study's senior
author.
"Hernia surgeons and patients should find ways to discuss sexual
health openly and frankly, as part of the pre-operative evaluation
and as part of the follow-up after repair," Soybel said by email.
With minimally-invasive procedures, 7.8% of patients developed
sexual dysfunction and 7.4% had painful sexual activity afterwards.
With more invasive "open" operations, 3.7% of patients had sexual
dysfunction and 12.5% had painful sexual activity.
These differences, however, were too small to rule out the
possibility that they were due to chance, according to the report in
the Journal of the American College of Surgeons.
Among the subset of men who had open procedures, 1.9% of those who
had general anesthesia developed sexual dysfunction compared with
6.2% who had local anesthesia. All of the studies that looked at
painful sexual activity included only procedures using general
anesthesia.
While the results suggest that men should discuss sexual side
effects of surgery with their doctors, it's possible that some
patients had sexual dysfunction or painful sexual activity as a
result of the hernia and not the procedures to repair them, Soybel
said.
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"Such symptoms may be caused by the presence of a groin hernia that
is causing pain, because of its being trapped in the hernia, or
pressure on structures that are important in sexual function, such
as the vas deferens or the blood vessels and nerves that supply the
testicle," Soybel said.
"After repair, the same structures may become tethered or trapped in
the scar that forms around the repair," Soybel added. "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 (causing pain) or interruption (causing
numbness), which can interfere with sensations that are part of the
experience of sexual intercourse."
The analysis wasn't designed to determine how hernias or surgery to
repair them might directly cause sexual health problems.
"We know that sexual dysfunction is a known possible complication
following inguinal hernia repair," said Dr. Kristoffer Andresen of
the department of surgery at Herlev Hospital in Denmark.
"The current study adds to the body of growing literature describing
this complication," Andresen, who wasn't involved in the study, said
by email. "Furthermore, the study highlights the need for including
this outcome in shared decision-making with patients as well as in
future studies of inguinal hernia repair."
SOURCE: https://bit.ly/2YIAN1c Journal of the American College of
Surgeons, online November 13, 2019.
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