Erectile dysfunction and sex after your hernia surgery

Two groups of men land on this page. Some have surgery coming up and want to know what it might do to their sex life. Others have already had it and something isn't right. There's an answer here for both.

The short version is that most men are fine, a minority aren't, and the ones who aren't tend to have a specific problem that's worth naming rather than worrying about.

Can hernia surgery cause erectile dysfunction?

An inguinal hernia repair works on the abdominal wall and the inguinal canal. It doesn't involve the blood vessels or nerves that produce an erection, so there's no route by which a routine repair causes erectile dysfunction the way, say, prostate surgery can.

What can happen is indirect. The spermatic cord runs through the area being repaired, and injury to it or to the nearby nerves is a recognised, uncommon complication.¹ Nerve damage can reduce sensation in the groin or scrotum, and that doesn't always recover. Pain, which is the more common problem, affects sex in an obvious way even when erections themselves are working normally.

Inguinal hernias are common, with around 20 million repairs carried out worldwide each year, and about 97% of groin hernias in men are the inguinal kind.^2,3 The vast majority of those men have no lasting effect on their sex life.

When can you have sex again?

Modern inguinal repair is designed to let you get back to normal activity quickly. There's no fixed period you have to wait, and current guidance is that men can return to their usual activities as soon as they feel able rather than following a set restriction.¹ For most men that means sex is comfortable somewhere between one and three weeks, sooner after keyhole surgery than open repair.

But you should look at it practically: If it hurts, stop and give it longer. Straining or pushing through pain in the first couple of weeks is worth avoiding, not because you'll undo the repair, which is more robust than it feels, but because pain in the early healing period is the thing most associated with pain later.

Your surgeon or the team who did your operation will give you advice specific to your repair, and that's what you should pay close attention to. If you were given a leaflet, it's the one to follow.

Pain during sex or ejaculation

Pain during sexual activity is a recognised complication of groin hernia repair. In one assessment of 538 men, 8.2% reported pain during sexual activity at an average of 33 months after their operation, and around 6% had sexual dysfunction related to it.⁴ Pain specifically on ejaculation, sometimes called dysejaculation, is part of the same picture.

The international guidelines are clear that men should be told about this risk before surgery.¹

It's usually linked to chronic post-operative groin pain rather than to anything about erections, which matters because it points to a different treatment route. Guidance recommends that chronic pain after hernia repair is managed actively, with nerve blocks and a multidisciplinary approach where needed, over a minimum of three months rather than being left to settle on its own.¹

The people to raise it with are the surgical team who did the repair, or your GP for a referral back. It's their complication to manage, and there are options.

Can the hernia itself cause problems, before any surgery?

A large inguinal hernia can extend into the scrotum, which is uncomfortable, makes sex awkward, and can be enough to put men off entirely. Some men also find the visible bulge affects their confidence, and that has its own effect.

The useful part is that repair often improves things. Several studies have found men reporting better sexual function after their hernia was fixed than before, precisely because the hernia had been the problem.^2,4 If your hernia has been getting in the way, surgery is more likely to help than to harm.

A hernia doesn't shrink your penis, though it can make it look different if a large hernia is distorting the surrounding anatomy. That resolves with repair.

What if erections haven't come back after months?

If it's been several months since your operation and erections still aren't right, then the surgery may be unlikely to be the whole story. Something else is often involved, and the two most common are worth knowing about.

Anxiety and monitoring: Surgery in that area, followed by a few uncomfortable attempts, is a very common route into a self-feeding cycle where the worry causes the problem. There's more on how anxiety affects erections, and it's more common than surgical injury by a wide margin.

Something physical that was already there: Erectile dysfunction is a recognised early sign of cardiovascular problems, and surgery is often just the moment a man starts paying attention. Worth ruling in or out rather than attributing to the operation. Other common causes include low testosterone and alcohol.

A consultation or a blood test will get you further than another few months of waiting.

When to get help urgently

Contact your surgical team, or use NHS 111 or A&E out of hours, if after your operation you have:

• Severe or worsening pain rather than pain that's gradually improving.

• Redness, heat, swelling or discharge at the wound, or a temperature.

• Sudden severe pain or swelling in a testicle.

• A new lump appearing where the hernia was, particularly with pain, vomiting or an inability to open your bowels.

The numan take

Routine hernia repair doesn't cause erectile dysfunction, and if your hernia has been getting in the way, fixing it will probably improve things rather than the reverse.

What does happen, for roughly one man in twelve, is pain during sex afterwards. The guidelines say you should be told about that before you consent, and plenty of men aren't. If it's happening to you, it has a name, it's recognised, and it's the surgical team's responsibility to sort out.

And if erections haven't come back months later, the surgery probably isn't the reason. That's worth finding out properly.

References

1. ^{Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080.}

2. ^{HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.}

3. ^{Wib O, Ge N. Inguinal Hernia. A Review. J Surg Oper Care. 2016;1(2).}

4. ^{Gutlic N, Petersson U, Rogmark P, Montgomery A. The relevance of sexual dysfunction related to groin pain after inguinal hernia repair - the SexIHQ Short Form questionnaire assessment. Front Surg. 2018;5:15.}