Hernia surgery and sexual dysfunction

[KevW]

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.

[DrBrown]

@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

[Good intentions]

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.

• This reply was modified 3 years, 3 months ago by  Good intentions.

[KevW]

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 3 years, 3 months ago by  KevW.

[drtowfigh]

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.