Hernia surgery and sexual dysfunction

Hernia Discussion Forums Hernia Discussion Hernia surgery and sexual dysfunction

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    • #28462
      KevW
      Participant

      I’m new to the forum so I apologize if this is something that’s already been discussed here in depth. I have a bilateral inguinal hernia. It’s going on four years now sense I was diagnosed and I’ve been putting off surgery primarily due to the horror stories that I keep coming across, in particular those involving sexual dysfunction. I’m hoping the doctors here can give me some helpful feedback regarding what surgical approach would be recommended for someone with these concerns. As I understand it (and I may very well be wrong), studies haven’t found a significant difference between the amount of post-op chronic pain and the type of procedure. Am I correct? But what about sexual function? I’m wondering if there is any type of procedure that has been shown to result in a lower number of sexual dysfunction complaints versus that found in other procedures.

      What are your thoughts on the Kugel technique? I’ve been considering this because, based on my reading, it avoids those nerves and structures that can become adherent to scar tissue or entrapped in the mesh when its placed anteriorly. From what I understand, scar tissue on the the three sensory nerves can cause chronic pain or numbness which is often responsible for the sexual dysfunction complaints. So I’ve been considering Kugel for these reasons. But then I recently came across a study showing a higher complication rate with posterior approaches verses anterior ones, so now I’m not so sure.

      What about open verses laparoscopic? On the one hand, I would have thought that open surgery would result in less nerve damage because the surgeon can physically see the nerves, vessels, and spermatic cord and take care that these aren’t compromised during the procedure or entrapped in the mesh. But on the other hand, the open surgery involves direct manipulation of these structures. Aren’t they physically moved out of the way during an open procedure? Doesn’t that alone pose a risk of damage or scar tissue? Which should be a greater concern?

      And then there’s the question of mesh versus no-mesh. Has any significant difference been found between mesh/no-mesh and sexual function after the surgery? And if no-mesh is the better option, which is the most advisable procedure when considering sexual function? I know that no-mesh procedures are usually done openly. So the pro is no mesh to contribute to scar tissue, nerve injury, etc., but the con is that those structures that are important for sexual function are in the playing field of the surgery, which brings me right back to considering the Kugel repair as it avoids those structures.

      As you can see, I’m overwhelmed in my options and I’m spinning. I’m not sure how much of what I said was accurate, but I’m hoping the doctors here can clear things up for me a bit and point me in the right direction. I’ve had a few consultations with doctors that specialize in one particular type of procedure. But I want to know, before getting the surgery, that I’m not being taylored for a specific type of procedure but rather, that a doctor has heard my concerns and a procedure is chosen in consideration of those concerns. I guess I feel that I haven’t yet gotten that kind of feedback, and I just don’t feel comfortable going through with surgery until I do. Any advice would be greatly appreciated!

    • #28463
      drtowfigh
      Keymaster

      Thanks for joining this forum. You can use the search function to find past discussions on sexual function.

      Based on your post, I recommend that you seek consultation with a hernia surgery specialist and get all your questions and concerns addresses. The surgeon can also tailor a plan of care to your needs.

      To answer your questions:
      – stay away from the Kugel patch and repair
      – open surgery with mesh has higher risk of nerve injury than all other procedures
      – hernia surgery does not affect sexual FUNCTION. Those nerves and organs are completely separate. There can be complications that cause pain with intercourse, ejaculation, or orgasm, but function is not directly affected.

      Note that my responses directly contradict some of your conceptions. This is why it’s so important to seek correct consultation to get correct information. Those of us who do this for a living can best digest the data out there for you as we have a global view. We can also therefore alleviate the anxiety from all the information you are reading on your own.

      You can also watch the HerniaTalk session I had with Dr Paul Turek, who is a male sexual function specialist and urologist.

    • #28477
      KevW
      Participant

      Dr. Towfigh,

      Thank you so much for your response. Last year I had a consultation with a surgeon who specializes in the Desarda technique, and I was told that the ilioinguinal nerve plays an important role in getting and maintaining an erection, so I hope you can understand my confusion. My conceptions aren’t just coming from reading on my own. I’m hearing doctors say seemingly different things. I say “seemingly” because I realize there may be misunderstandings on my end. This doctor explained to me that, because its a sensory nerve, damage to the ilioinguinal nerve has been known to result in numbness in the groin that can make it difficult to perform sexually, and he warned me that this could happen if the nerve becomes entrapped in a mesh implant or scar tissue. What are your thoughts on this? I’ve come across stories of patients experiencing numbness after the surgery and have lost the ability to become aroused. I’m not sure what to make of these stories now but I’ve been assuming that this was due to the damage of sensory nerves.

      After reading your response, I’ve decided to cross Kugel repair and any open-surgery with mesh off my list. So I guess the question for me now becomes one of open surgery without mesh vs. laparoscopic with mesh. Which would you say is the less riskier surgery if I’m concerned with nerve damage? What are your thoughts on Desarda, Kang, and Shouldice? How do these stand up against laparoscopic mesh surgery in terms of chronic pain and nerve damage? The Desarda specialist I spoke with warned me against Shouldice, saying that it’s even worse than mesh in terms of scar tissue that can aggravate the nerves.

      Again, I want to thank you for your response and helping to clear up some of my confusion. And I will definitely watch the HerniaTalk session with Dr. Turek.

      • This reply was modified 8 months ago by KevW.
    • #28480
      Good intentions
      Participant

      I had an odd dysfunction wherein the corpus cavernosa would not fill with blood but the glans, and I assume the corpus spongiosum (hard to tell but I think it’s the pathway to the glans) would. I had normal sensation but no erection, just a swollen glans. The problem got worse and worse over the months of the third year of having implanted mesh. After having the mesh removed all functions returned to normal, including the odd pulling sensations that I used to get in the first year of mesh, before things really started going downhill in the third year.

      I tried to describe this to my first surgeon, who said “that’s not my area” and referred me to a urologist, after getting angry and asking “can’t you just take a pill?”. The urologist was clueless about it and couldn’t even make a guess, even though, supposedly, he was a urologist. Right before I had the mesh removed I had to see another urologist to have my bladder examined for mesh intrusion/erosion, via internal camera. Her expertise was in women’s issues and she proposed that pelvic tightness might be a cause.

      Unfortunately, it’s just the nature of the area that people don’t really want to break things down in to the nerves and hydraulics and how it works. Even the pros don’t really want to talk about it, in-depth. They ignore it or pass it off to someone else or give you a prescription for one of the pills.

      My basic point is that I had correct function before mesh, slowly degraded performance with very specific anomalies compared to the usual “fix it with a pill” dysfunction when I had mesh, and that all of the correct function came back once the mesh was removed. I had had bilateral implantation of Bard Soft Mesh using the 2014 “state of the art” TEPP procedure, done by the chair of surgery at a large clinic who also was part of a group that taught laparoscopic methods and certified the students who completed the course as “trained”. I did all of the things I was supposed to do to get a good result, finding an expert surgeon who had done many procedures, and used the latest greatest material (lightweight mesh) but got a three year nightmare instead.

      Just one true story to consider. My problem was either due to nerve’s getting “numbed” so that they couldn’t control the vessels that control blood flow or because there was an actual physical blockage occurring, I think. It’s the only explanation that makes sense. But the fact that I could get 1/4 of an erection shows that the impetus was there but the work just could not be completed. Mesh can cause erectile dysfunction. What the odds are is not defined.

      Good luck. I would think twice or more about the Desarda surgeon’s comments about Shouldice. The number of Shouldice operations performance is probably thousands or even millions of times more than Desarda. I think he was talking his book, as they say. Making a sale. If they don’t have actual numbers, then they don’t really know.

    • #28511
      DrBrown
      Participant

      @kevw
      Dear Kevw.
      I agree with Dr. Towfigh. Avoid the Kugel repair.
      The ilioinguinal nerve is not involved with erections nor sexual function.
      If you are overweight, get your BMI down to normal before surgery.
      I prefer the open non mesh repairs.
      Regards.
      Bill Brown MD

    • #28541
      KevW
      Participant

      Dr. Brown,

      Thank you for your post.

      I’ve really busy with work and I haven’t yet had time yet to watch the HerniaTalk that Dr. Towfigh recommended, so these questions may be addressed there. But regarding the ilioinguinal nerve, it being a sensory nerve doesn’t cause issues with numbness that can lead to impotence? I keep coming across stories of men losing all sensation in their genitals after inguinal hernia repair, and I’ve been assuming that this was due to sensory nerve damage. I realize that not every member here is an expert, necessarily, but a member in another thread said this

      While the ilioinguinal and the genital branch of genitofemoral nerves do not directly innervate the penis. Both branches as they run distally near the base/root of penis and scrotum indirectly serve a sexual function by allowing proper support of an erection and retraction of scrotum. When the groin muscle of the base of your penis is numb from ilioinguinal being resected; denervated, you can’t hold up an erection upright strong like you would normally) and there will also be scrotal pain.

      What are your thoughts on this? Is there any truth to the above statement? I keep coming across statements of this kind, and its hard for me to reconcile them with others stating that the sensory nerves at risk in hernia surgery don’t impact sexual function.

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