By Lisa Rapaport

(Reuters Health) – – Many men experience sexual dysfunction or pain during sexual activity after groin surgery to repair a hernia, a research review suggests.

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.

“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: Journal of the American College of Surgeons, online November 13, 2019.