Sexual Disfunction risk after repair

[NFG12]

The spermatic cord gets so stuck to the mesh or encased with the scar tissue from it it can cause sexual disfunction and testicular pain. That’s why some and not many lose there testicle when getting the mesh removed even though it rarely happens.

[Alephy]

Chronic pain in general is not fully understood so it is not surprising that the same can be said for SD.
All known risks should be mentioned to the patient IMHO …ideally the surgeon would also mention the plan B if things go south but this is probably asking too much in the inguinal hernia battle field…

[William Bryant]

I think could it be the spermatic cord got pulled or stretched? And is setttling back?

[darntootin]

Hello. To give a real-life example, I had a left inguinal hernia surgery
in November 2022. It was a recurrent hernia, as my previous mesh repair from 13 years ago had failed. My first operation was laparoscopic, while my most recent one was open.

While I can say that generally the recovery from open surgery was worse, the main problem was that I experienced extreme ejaculation pain. I first tried a week after surgery. The pain came in waves leading up to ejaculation, and at the end the pain was terrible. It was so intense that it completely removed any kind of enjoyment.

I tried once a week after that, as it was too traumatic to try any more frequently. After 4 weeks the pain subsided a little, and by week 5 it was down to a small tingle. The pain would run up the left side of my genitals, with the major pain being on the lower side, near the left testicle.

I am about 8 weeks post-op now, and there is still a small tingle in the area, but it is nothing compared to before. I also have other issues, like numbness below the incision all the way to the genitals (not the genitals themselves), and a general uncomfortable feeling all over the area, but I’m just happy the first issue went away.

I have had a followup with my surgeon who said he has never had a patient with this complication before.

I write this here because I was desperate for any kind of help during those first 5 weeks, and I found some posts here that gave me hope. I wanted to add my story so that it can maybe give hope to someone else.

FYI I have had zero problems in this area before, so I attribute all of my issue to the second surgery.

[pinto]

The lead-off article of this thread does nothing but raise patient anxiety. In the middle of the article, it states,
“… 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.” The end quotes another expert as saying SD is a known possibility of surgical outcome. Well almost anything can be an outcome of surgery: To wit, @Good intentions claiming that a simple hernia surgery led to the loss of leg. (Well, not exactly because GI ignored that the patient had previously had multiple surgeries for it and massive scar tissue.) To say, that IH surgery can result in SD is meaningless without considering frequency. The latter however is a bit of a mystery because apparently there’s little research on it. The prudent thing would be to ask one’s surgeon about the prevalence of the SD outcome in his or her record.

• This reply was modified 1 year, 7 months ago by  pinto.

[William Bryant]

At least, according to this study although there is still a risk with tissue repair, it is less than the risk with mesh repairs.

“Ejaculatory pain is often located at the superficial inguinal ring that can last from a few minutes to several hours. Although dysejaculation is a rare complication of pure tissue repairs, the incidence of dysejaculation has increased with the widespread use of meshes for inguinal hernia repair.”

Take your point about ending up worse possibly but there are risks to almost all surgical procedures and that can apply to those procedures too. All you/we can do is our best to minimise them.

[Watchful]

I didn’t dig further into this particular potential complication. It’s just one of many possible complications with inguinal hernia surgery.

If your hernia becomes too symptomatic, what can you do? You have to go under the knife, and hope that the cure will be better than the disease in your case. It is scary that you might be trading a relatively minor problem for more serious problems, but the odds seem to be against something like that happening.

[William Bryant]

If there is a pain on ejaculation problem did they say if it resolves or remains.

Is there any remedial surgery?

[Watchful]

It is on the list of risks that some surgeons mentioned to me. For example, pain with ejaculation was mentioned, and one surgeon even mentioned that he started tightening the internal ring around the spermatic cord less during surgery after some of his patients complained about this problem.

[pinto]

You’re welcome, William. Absolutely, I’m sure you read correctly that hernia can cause sexual dysfunction. Well, how many cases from among the millions afflicted? And how is SD defined?

Should we include @Bob, as he seems to 1) include testicle pain; and 2) assign the cause to hernia. It so happens that Bob recently had hernia surgery. You don’t think that surgery had anything to do with it? And apparently his pain happened only post-op; otherwise he would have said he had the pain before surgery. I don’t mean to pick on Bob, and my apology if needed, but he did offer himself as a case of SD. Surely Bob’s case is an unlikely candidate. And if Bob happens to see this, let me say, Bob, I’m sorry to hear about your pain. Wouldn’t the first thought be it’s a byproduct of the surgery? (e.g., an instrument banged against you unfortunately; it’s a pretty delicate area down there, :D. I have no medical training but I’m sure your pain will clear up soon.

So among the presumed total of SD cases, not all will qualify as SD cases. Next you gotta tease apart many varied factors before you can confidently say it’s caused by hernia. I am not denying it as a cause; only that based on reading that article, it tells me little is known about the subject. Moreover I have asked docs about it and all denied it as a cause. 🙂

I completely understand your concern, William. I’ve been there, but we’re vulnerable to latching onto any shiny object good or ill that comes along. You are correct–absolutely so– to check how valid they may be. Unfortunately the hernia field in my view does not have a ton of proven research to guide many of the questions we have. I still have no idea how my first hernia came about! (Yeah, probably there was a defect but I am certain if I had led a couch potato life, I wouldn’t have gotten it.) I presume that the very very little said about hernia and SD means that it’s just a small chance happening to us. Good luck, bro.

[William Bryant]

Thanks Pinto.

I did notice it said the hernia could cause dysfunction!
But I’m not as analytical as yourself!
Nevertheless it did strike me as odd!

[Bob]

I’m 8 weeks out and have developed testicle pain after surgery which is making my life very uncomfortable daily. Not a chance of me having sex with this pain as it is now. I’m hoping that time will change this,but I can’t help but be worried.

[Watchful]

Seems reasonable that it could happen. For example, if something gets damaged in the spermatic cord.

[Good intentions]

William, PSA stands for Pain with Sexual Activity. It’s in the reference. They also provided the definitions.

“BACKGROUND:
The reported incidence rates of sexual dysfunction (SD) and pain with sexual activity (PSA) after inguinal hernia repair in males vary considerably. This meta-analysis explores the rates of SD and PSA after different surgical and anesthesia types to understand patient risk after inguinal hernia repair.”

” Definitions of SD and PSA focused on completion of intercourse for the former and pain with erection/ejaculation for the latter. “

[pinto]

Rapapart’s article could be the most confusing technical article due to its writing mechanics I’ve read . The upshot is medically the relation of SD and surgery is completely unknown–in the end the medical expert reports that a hernia itself could be the cause of SD.

Consider that hernia (IH) is quite common–nearly 25% of men experience it resulting in hernia being the most common surgery. Yet this is the first time for me to hear about the SD relation. I must conclude the chance of it happening must be very very unlikely. I imagine though if the IH is allowed to grow to be watermelon size, SD becomes quite likely (with or without surgery). Note also that various surgeons are heard to say that hernia is unrelated to sexual function.

William, hernia is very trying on you as I know from personal experience of having had them. It becomes a daily drag and can drain our spirit. Let me reassure you that SD really is more psychological than physical. Hernia becomes a battle not only physically.

It’s been said that researchers can somehow find whatever it is they want to find–if they look hard enough. Eventually someone will come up with “evidence” of hernia inducing car accidents. That SD news report seems concerning but I recommend you ignore it.

[William Bryant]

No I haven’t ruled out Dr Kang at all, Good Intentions, it’s manly distance putting me off, a bit the cost, and also the flying which I hate – ironic that since my dad had his private pilot’s licence and my mum went solo!!!

I didn’t inherit the daredevil gene!

Btw… What is PSA I’m your reply? Not prostate specific antigen?

[Good intentions]

I can’t remember all of your details or past posts. But have you penciled out the actual cost of going to see Dr. Kang in South Korea? Of all of the methods out there his seems to be the most minimally invasive, in all ways. Physically and anesthesia-wise. It seems the safest.

[William Bryant]

The risks seem to be becoming more and more. I’m tempted to put off surgery but find it frustrating that I can’t lift and carry like I used to before.

Also I have “slightly” enlarged prostate that will probably get worse plus general ageing wont make operation any easier I doubt.

Such a dilemma.

[Good intentions]

That is a really interesting article, thanks for posting. Dr. Andresen (not involved in the study) is one of the big names in hernia repair research.

Kind of disturbing that the conclusion of what to do with this information is only to include it in the informed-consent process with the patient. Not work on understanding the cause and fixing it.

And, of course, “open” and “minimally invasive” are used as catchalls for a huge variety of methods and materials.

The good news is that once all of the downsides of hernia repair are regularly disclosed to the patients before accepting surgery the patients can more powerfully drive improvement. By refusing to get surgeries that are not shown to avoid these problems.

https://journals.lww.com/journalacs/Abstract/2020/02000/Pain_and_Dysfunction_with_Sexual_Activity_after.8.aspx

Excerpt –

“CONCLUSIONS:
Sexual dysfunction and PSA are not rare after inguinal hernia repair. They should be included in preoperative discussions and as standard metrics in reporting outcomes of repair in large cohorts or trials.”

[Jtk2]

Thanks pinto, your post helped me to keep things positive. I have a right inguinal repair scheduled with Dr Yunis this coming week, so I’m beyond the point of no return. I will admit though that after reading the study, I was ready to run for the hills. I did bring up the issue of SD with Dr Yunis and he informed me that the operating area was unrelated to sexual function. hmmmmmmm. Will keep everyone updated on my results…

• This reply was modified 1 year, 7 months ago by  Jtk2.