Surgery for chronic inguinodynia following routine herniorrhaphy: beneficial effects on dysejaculation

Hernia. 2016 Feb;20(1):63-8. doi: 10.1007/s10029-015-1410-5. Epub 2015 Aug 11.


Purpose: 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).

Conclusion: 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.

Keywords: Dysejaculation; Herniorrhaphy; Mesh; Neurectomy; Post-Herniorrhaphy Dysejaculation Score.

MeSH terms

  • Adult
  • Aged
  • Chronic Pain / etiology
  • Chronic Pain / surgery
  • Denervation / methods*
  • Ejaculation*
  • Groin / surgery
  • Hernia, Inguinal / surgery*
  • Herniorrhaphy
  • Humans
  • Male
  • Middle Aged
  • Neuralgia / etiology
  • Neuralgia / surgery*
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / surgery
  • Sexual Dysfunction, Physiological / etiology
  • Sexual Dysfunction, Physiological / surgery*
  • Surveys and Questionnaires