Pain related sexual dysfunction after inguinal herniorrhaphy

Pain during and after sex is the most common problem that hernia mesh causes. Aasvang found that its incidence was 22.1% in males 18 to 40 years of age in the Danish hernia database. He also found that overall the incidence of chronic pain was 18.4%. The reports of the incidence of chronic pain in the medical literature range from 30% to 10%. The closest to a consensus from other hernia surgeons who I know and respect is that the correct number is a 20% incidence of chronic pain after mesh inguinal hernia surgery.

The vas deferens is a muscular and innervated tube which carries sperm from the testical to the prostate. Inguinal hernia repair, laparoscopic and open anterior approach, places mesh in direct contact with the vas deferens. Experimental implantation of mesh in dogs demonstrates complete obliteration of the vas deferens in 9 of 10 dogs. Human specimens demonstrate the mesh invading the wall of the vas and the neural plexus of the vas. There are reports of bilateral inguinal hernia repair being associated an increased incidence of infertility. It is only surprising that the incidence of pain related sexual dysfunction after mesh inguinal herniorrhaphy is not higher.