Can Surgery for Post-Inguinal Hernia Repair Affect Sexual Performance?

An inguinal hernia (essentially a hernia in the groin area) is already plenty to deal with on its own. There’s the pain, of course, but then many patients add to it the concern of whether their sexual performance will be affected by this condition or anything related to its treatment.

Sometimes, as a culture, we don’t tend to treat sexual matters with the gravity that we should. We sometimes treat someone’s focus on performance as a measure of pride or vanity, when many people are simply concerned about whether they can share intimate experiences with a significant love the way they could before the hernia repair.

This is a very normal and valid concern to have, and one you should never feel ashamed to ask any medical professional who is examining or addressing your inguinal hernia.

The fortunate news is that, in most cases, repairing an inguinal hernia should improve—or at least not worsen—sexual enjoyment, because the bulge that was associated with the previous hernia is repaired and the abdominal wall is strengthened.

However, a small percentage of patients who suffer from chronic pain after inguinal hernia repair, due to entrapment of several other nerves that provide sensation to the skin around the genitals (but generally not the genitals themselves), may experience serious problems with pain during intimate contact.

Patients may still have the desire for physical intimacy but, due to pain associated with touching the area around the genitals, the will quickly diminishes. This can understandably lead to frustration, anger, bitterness, and despair.

Surgery to remove these nerves (the ilioinguinal nerve, iliohypogastric, and genitofemoral nerves) that may be injured or stuck in scar tissue after a hernia repair should not worsen the ability to have sexual intimacy. The goal is to improve it by removing the source of the pain.

To discuss why, we will first look further at the inguinal hernia repair itself (as performed by other specialists), and then into the surgical procedure on the nerves we often perform if pain remains following the repair.

chronic nerve pain specialist

The Inguinal Hernia and Its Repair

According to Harvard Medical School, about 1 in 4 men will develop an inguinal hernia at some point in their life. A case of an inguinal hernia in a woman is far from unheard of, but the condition remains much more common in men.

While most cases present very minor or no symptoms whatsoever, and therefore rarely require action, about 1 in 7 will have an inguinal hernia that is deemed in need of surgical repair.

In a study published by the International Journal of Urology, about 23 percent of a pool of 224 hernia patients (including 14 women) reported sexual dysfunction before the hernia repair procedure. After the procedure, 16 percent of patients reported similar problems.

Of course, having any sort of discomfort in your groin area is bound to have a negative effect on sexual desire and performance. According to studies, common symptoms patients have described before or even after an inguinal hernia repair procedure include:

  • Pain in becoming erect.
  • Inability to achieve or maintain an erection.
  • Pain with orgasm.
  • Pain with physical body contact of the groin.

Pain before and after the surgical procedure tends to be the primary cause of the sexual dysfunction, and not the condition or procedure itself causing any direct consequence.

In rare cases, if there is a direct relation to the procedure, studies suggest it may have to do with the implanted mesh affecting tissue within the area in some cases. However, further research on this matter has been suggested.

What About Surgery to Address Pain Following a Hernia Repair?

Pain in most patients with a hernia repair resolves with time and recovery. Once that pain subsides, the effects it has on sexual performance tend to fade as well.

But if you are reading this, odds are you or someone you know is still having pain after a hernia repair! It is important to know that this does not necessarily mean the surgeon did something wrong.

However, if it has been 6 months or more after a surgery and pain persists, there is the potential that a nerve has been negatively affected as part of the procedure. It is possible that a nerve was cut, scar tissue has developed around a nerve, or that a nerve has become caught within the mesh insert that was used to repair the hernia itself.

In such situations, Dr. Williams is often consulted to address the issue, and we perform a thorough evaluation to determine whether a nerve is being affected and—if so—where it is. This often involves the use of a nerve block—an injection of anesthetic in the area of a nerve—to determine whether particular nerves are currently irritated or damaged.

In a few cases, a nerve may need to be released from scar tissue. In many others, however, a nerve or nerves may need to be removed to provide relief to the area. When this is done, numbness will occur in the area, although the size of this area of numbness shrinks over time in the majority of situations.

But will this numbness have any effect on sexual pleasure or enjoyment? The answer is no, it should not in any way whatsoever. In fact, it will likely make things better!

The nerves that may be causing chronic pain following inguinal surgery are not the same as those that control sexual function and pleasure.

The nerves that are primarily responsible for sexual arousal (the pudendal nerves) are typically not present in the surgical site of a hernia and are not the same as those responsible for erection or arousal. A proper surgical procedure should not affect those nerves in any way.

Surgery to remove the nerves responsible for the pain (the ilioinguinal, iliohypogastric, and genitofemoral nerves), would improve or—under best circumstances—eliminate the pain that has made attempts at sex an ordeal to begin with.

In many cases, the same incision used for the initial repair can also be used again, reducing the risks of cutting into new nerves.

Now, this does not eliminate the small possibility that another factor may be influencing performance. Such questions might be best relayed to your hernia specialist and/or the surgeon who performed the initial procedure. A consultation with a urologist or gynecologist may be in order as well.

Get Help for Chronic Post-Surgical Pain

While sexual enjoyment is indeed a valid concern, so is pain that becomes a daily impediment to your life. We can discuss both issues with you, and help you come to a decision on treatment that best fits your needs.

Call our office at (410) 709-3868 to schedule an appointment at our Baltimore area office. If you prefer to reach us electronically, please fill out our online contact form and a member of our staff will reach out to you during office hours.

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.
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