Hernia Surgery Can Affect Your Sex Life, But Maybe Not the Way You Fear

Mention "inguinal hernia" to a man and he's likely to wince. It's another of those phrases, like "testicular torsion" or "penile fracture," that conjure up painful images of private parts.

Unfortunately, hernias are common. In fact, more than 1 million hernia repairs are performed annually in the United States, and about 800,000 are for inguinal hernias, according to the Food and Drug Administration (FDA). That's a lot of wincing, and with good reason, if you're concerned about your sexual health.

"When considering hernia repair, it is important to always think about the potential implications it can have on male sexual function," said Justin Dubin, M.D., a urology fellow specializing in male infertility and sexual medicine in Miami. "This is because inguinal hernia repairs are performed in a region of the body where vital structures to the testicle and other nerves for sexual function are located."

About 27 percent of men and 3 percent of women will develop an inguinal hernia at some point in their life.

While a small percentage of men may experience pain or sexual dysfunction after hernia surgery, they can be helped in most cases.

For some men, hernia repair surgery may be a boon to their sex life.

"Data suggests that sexual function—erectile function, orgasm satisfaction, overall satisfaction and quality of life—improves after hernia surgery," Dubin said. "This is likely due to the pain, discomfort and cosmetic concerns that come with having a hernia. Repairing hernias can, in effect, repair many of the sexual health issues that come with having one."

What is an inguinal hernia?

A hernia happens when an internal body part pushes through a weakness in the surrounding muscle wall. An inguinal hernia occurs in the groin area. Internal tissue, perhaps part of your bowel, pushes into your groin at the top of your inner thigh into an area called the inguinal canal. Most often, the inguinal hernia contains fat or part of the small intestine.

Inguinal hernias are pretty common but not at all the rule. About 27 percent of men and 3 percent of women will develop an inguinal hernia at some point in their life, the National Institutes of Health (NIH) reports.

How can you tell if you have an inguinal hernia? Look for the primary symptoms:

• Bulging in the groin area
• For men, a bulge in the scrotum
• Discomfort or pain in the groin
• A feeling of heaviness in the groin
• Burning sensations in the groin

If the hernia becomes severe, stuck or strangulated, the symptoms can worsen and the list grows to include:

• A bulge that has suddenly become larger
• You can no longer massage the hernia bulge back inside
• Fever
• Redness in the groin area
• Severe pain
• Abdominal pain, bloating, nausea and vomiting (all symptoms of intestinal obstruction)

These severe symptoms signal an emergency. You should seek medical attention right away if you have a hernia and these types of symptoms develop.

Most people will need surgery to repair an inguinal hernia, but not all surgeries are the same.

What does inguinal hernia surgery entail?

Inguinal hernia repair can be performed either as open or keyhole surgery, said Thomas Satyadas, FRCS, consultant general surgeon and an advanced laparoscopic surgeon at the Central Manchester NHS Foundation Trust in the United Kingdom.

"For most people, the procedure can be done laparoscopically, which will involve three to five keyhole cuts under an anesthetic," Satyadas said. "Most of the time, a mesh is used to close and strengthen the abdominal wall. Different types of mesh, light and heavy, are available to use in the procedure, and surgeons can use different ways of fixing the mesh, too."

If the surgery is performed openly, a larger cut is made in the groin area to repair the hernia. Although mesh is often used for repair, some surgeons might choose to use stitches alone to close the weak area in the abdominal wall.

Most people go home the same day of the procedure, according to Satyadas, though the patient's health before the surgery can affect that timeline. Doctors usually advise patients not to drive for about two weeks, and in four to six weeks, the majority of people can resume their everyday activities.

Sexual side effects of hernia surgery

As Dubin stated, the location of the hernia repair surgery can potentially put the testicles and the structures around them at risk.

His list of potential risks after surgery include:

• Hematoma: Blood collects in the area of the procedure.
• Seroma: Bodily fluids other than blood collect in the area.
• Orchitis: An infection of the testicle.
• Testicular atrophy: Shrinking of the testicles can result in decreased testicular function. Rates of atrophy are less than 1 percent.
• Damage to the vas deferens: Sperm travel through the vas deferens when you ejaculate. Injury to the vas deferens can prevent sperm from leaving your testicle and therefore affect fertility. The risk of this happening is less than 2 percent.
• Chronic testicular pain, pain during sexual activity and pain during ejaculation: Rates of ejaculatory pain are around 2 percent to 3 percent. The percentage of men who experience pain with sexual activity has been reported to be 2 percent to 10 percent.

"Erectile dysfunction has been said to be a possible issue. Still, there is no robust data showing that hernia repair can cause it," Dubin said. "Despite the location of the surgery, sexual function issues after inguinal hernia repair surgery are thankfully low.

For erections specifically, such a surgery is probably not going to lead to ED, said Vaibhav Modgil, a consultant urological surgeon and andrologist at Manchester Andrology Centre and Manchester Royal Infirmary in the U.K. However, he and his colleagues do see people who have testicular problems after surgery.

"It's not uncommon for men to complain of testicular pain or fluid collection in the testes," he said.

About 3 to 5 percent of patients who undergo a laparoscopic inguinal hernia repair surgery complain of chronic groin pain; the percentage is higher in men who have an open repair, according to Satyadas. He added that lightweight mesh used during surgery can reduce the risk of chronic groin pain and—perhaps as importantly—postoperative sexual dysfunction.

Satyadas pointed to a paper published in the Journal of the American College of Surgeons. The paper analyzed data from several previous studies that included 4,884 men who had an inguinal hernia repair. Overall, after surgery, the data showed that 5.3 percent of men developed sexual dysfunction and 9 percent of men developed pain during sexual activity

"So sexual function problems are not very common, but they are not rare, either," he said.

How to manage postsurgical problems

Chronic groin pain can be an issue for some patients, but Satyadas said a variety of treatment options are available: numbing injections to reduce pain in the area; nerve ablation, which involves burning the nerve so it doesn't cause chronic pain; and removal of the nerve.

"These treatment options are not usually [considered] because the patient has sexual function problems, but because they have chronic pain," he said. "However, one would assume that if you do have chronic groin pain, you are likely to have reduced sexual activity or sexual dysfunction. So the two can go hand in hand."

Ice and compression are often the best ways to manage reversible issues such as hematomas and seromas, according to Dubin. If an infection develops in a testicle after surgery, oral antibiotics are the go-to treatment.

"Additional surgery to treat these issues is rare, and in situations where chronic pain is involved, we usually try other treatment options before considering surgical treatment," Dubin said. "The only issue that requires rapid and emergent surgical intervention is an ischemic testicle, which occurs less than 1 percent of the time."

Satyadas suggested that sexual dysfunction following surgery is becoming more recognized, but doctors need to help men become more comfortable talking about it, including how to ask the right questions at the right times.

"The more you discuss sexual function before surgery, the more likely problems postsurgery can be identified and managed," Satyadas said.

Can fertility be affected by hernia surgery?

While hernia surgery rarely cuts off blood flow to a testicle, it can happen. Fortunately, if the issue is caught promptly, it can be surgically repaired, Dubin said. Once a testicle is dead or atrophied, however, there is no medical way to reverse the damage and the testicle may need to be removed if it causes pain.

"If a vas deferens is injured, there is really nothing we can do to repair it," Dubin said. "The good news is you have two testicles with two vas deferens, and in general, injury to one vas deferens or testicle should not affect your overall fertility."

Modgil agreed that most men can be perfectly fertile with one testicle. Keep in mind, though, that anything which affects the testes can affect a man's fertility. If damage develops in one testicle and the other already has fertility issues, the man will then have a serious issue. Fortunately, fertility issues are very rare after inguinal hernia repair surgery, Modgil stressed.

The same goes for erectile dysfunction, which is unlikely to be directly linked to hernia surgery. Patients who experience erection problems after surgery likely developed them before surgery, due to risks such as diabetes, central obesity, smoking or underlying vascular/heart problems, Modgil said.

"If men are concerned about their erections, it is best to speak to a medical professional and have baseline blood tests," he said. "Changing your lifestyle and being as healthy as you can are the first steps to treating erectile dysfunction."