Sexual Dysfunction After Anorectal Surgery

Understanding the Mechanism of Dysfunction

Sexual dysfunction from chronic pelvic floor dysfunction following hemorrhoidectomy, fissurectomy, and fistulotomy is treatable, not permanent, with good prognosis for recovery through targeted pelvic floor rehabilitation, though outcomes depend on whether the dysfunction stems from denervation/devascularization versus reversible muscle dysfunction 1, 2, 3
The key distinction determining treatability is whether the dysfunction results from functional complications (devascularization and denervation) leading to persistent pain and dyspareunia, which represent more permanent anatomical changes 1, 2, 3

Pelvic floor physical therapy is the cornerstone treatment, as it improves sexual pain, arousal, lubrication, orgasm, and satisfaction, according to the National Comprehensive Cancer Network 4, 5
Water-, oil-, or silicone-based lubricants should be used for any dyspareunia during the recovery period, as recommended by the National Comprehensive Cancer Network and the Journal of Clinical Oncology 4, 5, 6
Topical lidocaine applied to painful areas before sexual activity can help with persistent introital pain and dyspareunia, as suggested by the Journal of Clinical Oncology 5
Vaginal dilators can be used if vaginismus or vaginal stenosis is present, although this is less relevant for anorectal surgery unless there's vaginal involvement, according to the National Comprehensive Cancer Network and the Journal of Clinical Oncology 4, 5
Cognitive behavioral therapy addresses anxiety, fear, and psychological components that commonly develop after surgical trauma, as recommended by the National Comprehensive Cancer Network and the Journal of Clinical Oncology 4, 5

Screen for medications impairing sexual function, particularly narcotics and any serotonin reuptake inhibitors, as suggested by the National Comprehensive Cancer Network 4
Evaluate for depression and anxiety, which frequently develop after pelvic surgery and exacerbate sexual dysfunction, according to the National Comprehensive Cancer Network 4, 5

If significant nerve damage (pudendal neuropathy) or vascular injury occurred during surgery, some degree of permanent dysfunction may persist despite optimal rehabilitation, as noted by the American College of Radiology 1, 2, 3

Refer to a pelvic pain specialist or urogynecologist if severe, unremitting pain suggests nerve injury, as recommended by the Journal of Clinical Oncology and the American College of Radiology 1, 5
Suspected anatomical complications requiring imaging (MRI pelvis would be the preferred modality for soft tissue evaluation) should be referred to a specialist, according to the American College of Radiology 1, 2, 3