title: Impairment of sexual activity before and after endoscopic totally extraperitoneal (TEP) hernia repair.
abstract: BACKGROUND
  In patients with inguinal hernias, sexual activity may be impaired due to hernia-related pain. Surgical repair may improve these complaints but can also lead to similar symptoms as a long-term complication of the operation. Endoscopic hernia repair is associated with less postoperative pain and earlier return to normal activities, but its effect on pain-related sexual function is unknown. In this study, the incidence and effect of pain related to sexual activity are evaluated before and after endoscopic totally extraperitoneal (TEP) hernia repair.
  
  
  METHODS
  A hospital-based questionnaire study of pain-related sexual dysfunction was conducted in November 2009 in 500 male patients ≥18 years, who underwent TEP repair of a primary hernia between March 2006 and December 2008. The response rate was 77.2%.
  
  
  RESULTS
  Pain of any severity during sexual activity was reported by 124 patients (32.1%) preoperatively and 35 patients (9.1%) postoperatively. Only 2.3% of the 262 patients with no history of preoperative pain experienced moderate to severe (VAS 4-10) pain postoperatively. Pain impaired sexual function in 63 patients (16.3%) preoperatively and in 18 patients (4.7%) postoperatively. The majority of patients who reported pain during sexual activity preoperatively (n = 102, 82.3%) had no pain postoperatively. The frequency of moderate to severe painful sexual activity decreased from 21.2% (preoperatively) to 3.4% after TEP repair (P < 0.001), and the frequency of moderate to severely impaired sexual function decreased from 6.0 to 1.0% (P < 0.001). The preoperative presence of pain during sexual activity and chronic non-hernia-related pain syndromes were predictive for the occurrence of postoperative pain.
  
  
  CONCLUSIONS
  Painful sexual activity, present in one third of patients with inguinal hernias, improved in the majority of patients following TEP hernia repair. Postoperatively, moderate to severe painful sexual activity occurred in 2.3% of the patients with no history of preoperative complaints.
authors.affiliation: Department of Surgery, Diakonessenhuis, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands. nschouten@diakhuis.nl
authors.forename: N
authors.initials: N
authors.lastname: Schouten
authors.forename: T
authors.initials: T
authors.lastname: van Dalen
authors.forename: N
authors.initials: N
authors.lastname: Smakman
authors.forename: G J
authors.initials: GJ
authors.lastname: Clevers
authors.forename: P H P
authors.initials: PH
authors.lastname: Davids
authors.forename: E J M M
authors.initials: EJ
authors.lastname: Verleisdonk
authors.forename: H
authors.initials: H
authors.lastname: Tekatli
authors.forename: J P J
authors.initials: JP
authors.lastname: Burgmans
mesh_terms: D000328:Adult; D003075:Coitus; D004724:Endoscopy / Q000009:adverse effects*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires