Sex and Anal Surgery

ND Carr MB, ChB, MD, FRCS, Swansea NHS Trust

Consultant colorectal surgeon

INTRODUCTION:

Although the consequences of rectal excision and other forms of pelvic surgery on sexual function have been intensively investigated, the effects of anal surgery on sexual function remain unknown. The present paper attempts to review the effects of anal surgery on vaginal, anal and oral sexual practice

METHODOLOGY:

Using an EMBASE & PUBMED search (1995 to 2007) of all types of anal operations cross referenced against sexual behaviour, sexual function, sexual dysfunction, sexual intercourse, homosexuality, coitus and anal sex, only 9 papers satisfied these criteria. This increased to 25 when rectocoele repair was added into the search. Moreover a search of The Cochrane Library, using an input of ‘sex and anal surgery’ only revealed 27 hits from 5053 sites. Most of these do not address the aims of the present study. By contrast, a GOOGLE search using the same criteria resulted in 2,300,000 hits and blogs

RESULTS:

It is apparent from published data that some facts emerge:

i/ Six papers addressed the problem of female sexual function (total cohort = 507 patients; median = 52; range 26 to 257) after anal sphincteroplasty or dynamic graciloplasty for anorectal incontinence (ARI). All these studies used quality of life (QOL) analysis as an outcome measure. An improvement in sexual function was reported from 4 studies, whilst 2 reported no change. Only 1 paper reported the correlation between postoperative FISI and PISQ-12. There was no correlation between the degree of ARI after surgery and sexual satisfaction and the authors suggest that women who have undergone surgery for ARI, and have not achieved a good result, undergo a “response shift” and change their ways of gaining sexual satisfaction

ii/ With respect to rectocoele repair, several facts emerged. Eleven papers (total number of patients = 851; median 89; range = 26 to 125) were examined. Using QOL tools, 9 out of 11 studies reported an improvement in sexual well being on behalf of the female participants. Six of the 11 studies specifically reported on dyspareunia, which was reported to be worse after repair (median = 30%; range 0% to 41%)

iii/ Information surrounding the advisability or not of anoreceptive intercourse amongst both hetero and homosexual individuals (2.5% of the population) has not been adequately addressed after stapled haemorroidectomy and this (N = 3 letters) was a suprising observation. Nevertheless, it is likely that anoreceptive practices are painful and may result in condom or penile injury if taken up too soon after surgery

Information gained from GOOGLE could not be quantitated and a ‘thematic’ approach was adopted in order to assess any general trends in public anxiety. The timing of anoreceptive intercourse after haemorrhoidectomy was a common blog theme, as was the difficulty experienced by patients with anorectal sepsis in the practice of oral, anal and vaginal sex

CONCLUSIONS

There remains a paucity of information with respect to how anal surgery affects sexual practice. Bearing in mind that sexual satisfaction remains a basic human desire and that anal surgery is common, the author believes the subject requires more attention