Hernia repair improves pain during sexual engagement among inguinal hernia patients

Sweden: Patients with inguinal hernias experience pain during sexual engagement more frequently than is thought, which lowers the quality of life, says an article published in Surgery journal. The study further added that repair of inguinal hernia will noticeably lessen pain at sexual activity and restore quality of life in most patients without difference between techniques whether it is total extraperitoneal or Lichtenstein repair.

It is not well understood why inguinal hernias produce pain during sexual activity or why they heal. Preoperative and postoperative reported frequencies to range from 10% to 15% and 25% to 30%, respectively. The main goal of this study, which was carried out by Allan Gutlic and colleagues to compare complete extraperitoneal with Lichtenstein repair in terms of discomfort during sexual activity after one year.

Men between the ages of 30 and 60 with a primary inguinal hernia were randomly assigned to receive complete extraperitoneal surgery without mesh fixation or Lichtenstein repair. A questionnaire was created to measure the prevalence, frequency, severity, and impairment of sexual functions brought on by pain during the sexual engagement. A clinical examination, a sexual function questionnaire, and the 36-Item Short Form Survey were completed prior to surgery as well as at 1 and 3 years afterward. An investigation of the risk factors for sexual activity-related pain was conducted.

The key findings of this study were:

• Between 2008 and 2014, 243 patients were enrolled (111 total extraperitoneal and 132 Lichtenstein); 97% of them persisted for 1-year analysis and 90% for 3-year study.
• Preoperative pain during sexual activity was reported in 35% of cases; at 1 year and 3 years, this decreased to 5.9% overall and 12.5% in Lichtenstein (P =.098) and 7.0% overall and 9.3% in Lichtenstein, respectively.
• Patients who had discomfort during sexual activity had a much lower quality of life before surgery, but this improved to nearly normal levels after 1 and 3 years.
• At one year, eight patients (3.6%) reported experiencing new discomfort during the sexual engagement.
• Preoperative discomfort and the Lichtenstein method were risk factors for experiencing postoperative pain during the sexual engagement.

"In the majority of the patients, the repair will significantly less pain during sexual activity and restore quality of life without a modification in approach. Patients should be made aware of any possible links between having an inguinal hernia and having difficulty becoming sexually active," added the PI in conclusion.

Reference: 

Gutlic, A., Rogmark, P., Gutlic, N., Petersson, U., & Montgomery, A. (2022). Pain with sexual activity at 1 and 3 years: Comparing total extraperitoneal with Lichtenstein inguinal hernia repair in a randomized setting (TEPLICH trial). In Surgery. Elsevier BV. https://doi.org/10.1016/j.surg.2022.07.013