title: Sexual dysfunction after inguinal hernia repair with the Onstep versus Lichtenstein technique: A randomized clinical trial.
abstract: Sequelae after inguinal hernia repair include pain-related impairment of sexual function. Pain during intercourse can originate from the scar, scrotum, penis, or during ejaculation. The aim of this study was to investigate if the Onstep technique resulted in better results than the Lichtenstein technique regarding pain-related impairment of sexual function.
  
  
  
  This study was part of the randomized ONLI trial (NCT01753219, Onstep versus Lichtenstein for inguinal hernia repair). Separate reporting of pain-related impairment of sexual function was planned before the study start, with a separate sample size calculation. Participants were randomized to the Onstep or Lichtenstein technique for repair of their primary inguinal hernia and followed up at 6 months postoperative with the use of a questionnaire specific for pain-related impairment of sexual function.
  
  
  
  A total of 259 patients completed the 6-month follow-up, 129 in the Lichtenstein group and 130 in the Onstep group. Among the patients operated with the Onstep technique, 17 experienced pain during sexual activity 6 months after operation compared with 30 patients operated with the Lichtenstein technique (P = .034). Both subgroups that experienced pain during sexual activity had a median visual analog scale score of 0 with an interquartile range of 0 to 2 (P = .349). The Lichtenstein technique resulted in new pain in 14 patients, whereas the Onstep procedure gave new pain in 7 patients (P = .073).
  
  
  
  The Onstep technique was superior to the Lichtenstein technique in terms of pain during sexual activity 6 months after operation.
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: kristofferandresen@gmail.com.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Andresen
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Burcharth
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Siv
authors.initials: S
authors.lastname: Fonnes
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Line
authors.initials: L
authors.lastname: Hupfeld
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Josephine Philip
authors.initials: JP
authors.lastname: Rothman
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Deigaard
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Dorte
authors.initials: D
authors.lastname: Winther
authors.affiliation: Department of Surgery, Horsens Hospital, Horsens, Denmark.
authors.forename: Maj-Britt
authors.initials: MB
authors.lastname: Errebo
authors.affiliation: Department of Surgery, Horsens Hospital, Horsens, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Therkildsen
authors.affiliation: Department of Surgery, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Dina
authors.initials: D
authors.lastname: Hauge
authors.affiliation: University Hospital Aalborg, Dagkirurgisk Center Hobro, Hobro, Denmark.
authors.forename: Fritz Søbæk
authors.initials: FS
authors.lastname: Sørensen
authors.affiliation: Department of Surgery, Sygehus Lillebælt, Kolding Hospital, Kolding, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Bjerg
authors.affiliation: Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012737:Sex Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult