title: Surgery for chronic inguinodynia following routine herniorrhaphy: beneficial effects on dysejaculation.
abstract: OBJECTIVE
  Pain during sexual activities and ejaculation is reported by 3-4% of men after routine inguinal herniorrhaphy. The potential beneficial effects of surgery for chronic groin pain on dysejaculation are unknown. The objective of this study was to determine dysejaculation rates in a series of patients reporting chronic postherniorrhaphy pain and evaluate the effects of tailored neurectomy on dysejaculation.
  
  
  METHODS
  We evaluated male patients (>18 years) operated for chronic groin pain after inguinal herniorrhaphy during a 6-year time period (2004-2010). Dysejaculation was defined as a burning or searing sensation associated with ejaculation. Men reporting symptoms possibly associated with dysejaculation were sent a questionnaire investigating pain characteristics (VAS, 0-100), influence on sex life and effects of the tailored neurectomy. A Post-Herniorrhaphy Dysejaculation Score (PHDS, 0-12 points) was introduced to quantify the severity of the dysejaculation syndrome.
  
  
  RESULTS
  A series of 100 males operated for chronic inguinal pain after standard herniorrhaphy were studied. Thirty-four men reported symptoms of dysejaculation prior to the tailored neurectomy. Sex life was negatively influenced in 20 of these, and 5 completely abstained from any sexual activity. Following surgery including tailored neurectomy, funicular release and/or mesh removal, VAS for dysejaculation pain was significantly reduced [n = 20, 55 (95% CI 47-63) versus 21 (95% CI 13-29), p < 0.001]. PHDS scores were also significantly attenuated [n = 20, 10 (3-12) versus 2 (0-10), p < 0.001]. Sex life normalized in two-thirds of these men (13/20).
  
  
  CONCLUSIONS
  Dysejaculation in men suffering from chronic pain after routine inguinal herniorrhaphy is not uncommon. A tailored neurectomy, funicular release and/or mesh removal offer relief in the majority of these patients.
authors.affiliation: Department of General Surgery, Solvimáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands. tim.verhagen@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: Verhagen
authors.affiliation: Department of General Surgery, Solvimáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.
authors.forename: M J A
authors.initials: MJ
authors.lastname: Loos
authors.affiliation: Department of General Surgery, Solvimáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.|CARIM Research School, Maastricht University, P.O. Box 606, 6200 MD, Maastricht, The Netherlands.
authors.forename: M R M
authors.initials: MR
authors.lastname: Scheltinga
authors.affiliation: Department of General Surgery, Solvimáx, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Center, PO Box 7777, 5500 MB, Veldhoven, The Netherlands.|GROW Research School, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: R M H
authors.initials: RM
authors.lastname: Roumen
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology / Q000601:surgery; D003714:Denervation / Q000379:methods*; D004542:Ejaculation; D006119:Groin / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000601:surgery*; D011795:Surveys and Questionnaires
keywords: Dysejaculation; Herniorrhaphy; Mesh; Neurectomy; Post-Herniorrhaphy Dysejaculation Score