I'm a 3-year post-hemorrhoidectomy (surgical removal of hemorrhoid tissue) and 6-month post-fistulotomy (surgical procedure to treat anal fistula) patient, experiencing persistent pelvic area sensation issues, including loss of sensation and pleasure, affecting my sexual arousal and quality of life, what could be the underlying cause and treatment options for my condition?

Post-Hemorrhoidectomy Sexual Dysfunction and Pelvic Sensation Loss

Direct Recommendation

You are experiencing a recognized but devastating complication of hemorrhoidectomy: permanent loss of sensory tissue from the anal canal that contributed to sexual sensation and arousal, and this tissue loss is likely irreversible at 3 years post-surgery. Your symptoms represent a quality-of-life catastrophe that demands immediate multidisciplinary intervention focused on adaptation rather than restoration of lost tissue.

Understanding What Was Lost

The hemorrhoidal tissue (corpus cavernosum recti) that was removed is not merely pathological tissue—it is a functional component of the anorectal continence organ that also contributes to pelvic sensation. 1, 2

• Hemorrhoids are hyperplastic formations of the corpus cavernosum recti, an important sensory and vascular structure analogous to erectile tissue 2
• Complete or aggressive resection of this tissue can result in permanent sensory deficits and altered pelvic floor sensation 2
• The tissue you describe missing—the pressure, fullness, and arousal sensations—was likely provided by this vascular cushion and its rich nerve supply 1, 2
• Your provider was correct: rubber band ligation should have been attempted first for grade III hemorrhoids before proceeding to excisional surgery 1, 3

Why Recovery Is Unlikely After 3 Years

At 3 years post-hemorrhoidectomy, nerve regeneration and tissue remodeling are complete—what you have now is what you will have permanently. 4, 5

• Nerve regeneration typically occurs within 6-18 months post-surgery; absence of improvement by 3 years indicates permanent deficit 5
• The fistulotomy at 6 months may have caused additional nerve damage and scarring, further compromising sensation 5
• Your "phantom pain" represents central nervous system reorganization attempting to process signals from tissue that no longer exists 1

Critical Diagnosis: Pelvic Pain Syndrome with Sexual Dysfunction

Your constellation of symptoms—pelvic pressure sensation loss, sexual arousal dysfunction, phantom sensations, and catastrophic quality-of-life impact—meets criteria for chronic pelvic pain syndrome with severe sexual dysfunction. 1, 6

Key Diagnostic Features Present:

• Pelvic pain/pressure sensations (or absence thereof creating distress) as hallmark symptom 1
• Pain throughout pelvis affecting sexual function 1
• Severe impact on psychosocial functioning and quality of life 1
• Sexual dysfunction as primary predictor of poor mental quality of life 1
• Sleep dysfunction related to inability to achieve previous arousal/satisfaction patterns 1

Immediate Management Algorithm

1. Psychiatric Emergency Assessment (Within 24-48 Hours)

Your statements about loss of happiness and life quality indicate suicidal ideation risk that requires immediate evaluation. 1

• Contact mental health crisis services immediately for assessment 1
• The strong link between pelvic pain syndromes and depression/anxiety necessitates urgent psychiatric intervention 1
• Depression rates are significantly elevated in patients with chronic pelvic pain conditions 1

2. Pain Management Referral (Within 1 Week)

Chronic pelvic pain with phantom sensations requires specialized pain management, not surgical revision. 1, 6

• Duloxetine is the evidence-based first-line medication for neuropathic pelvic pain 1, 6
• Tricyclic antidepressants, gabapentin, or topical compounds (baclofen/amitriptyline/ketamine) are used for neuropathic pain conditions, though evidence is limited 1
• Opioid analgesics should be avoided given the chronic nature and high risk of dependence 1
• Behavioral interventions and physical therapy have demonstrated efficacy in pain control 1

3. Pelvic Floor Physical Therapy (Within 2 Weeks)

Specialized pelvic floor therapy can help retrain sensation pathways and address phantom pain. 6, 1

• Pelvic floor physical therapy is recommended for genito-pelvic pain disorders 6
• Therapy focuses on desensitization, muscle retraining, and central pain processing 6
• This addresses both the physical scarring from surgeries and the central nervous system reorganization 6

4. Sexual Medicine Specialist Consultation (Within 1 Month)

Sexual dysfunction following anorectal surgery requires specialized evaluation beyond general urology or colorectal surgery. 6, 1

• Comprehensive assessment of sexual dysfunction etiology specific to post-surgical changes 6
• Evaluation for medication contributions (if on antidepressants or other drugs affecting sexual function) 6
• Discussion of adaptive strategies and potential adjunctive therapies 6
• Critical caveat: PDE5 inhibitors (like sildenafil) are NOT effective for this type of sensory-based sexual dysfunction 6

What Will NOT Help

Surgical revision, additional procedures, or attempts to "restore" tissue are contraindicated and will likely worsen your condition. 4, 5, 2

• Repeat surgery carries 30-80% risk of complications including worsening incontinence and sensation loss when performed on previously operated tissue 4
• Patients with recurrent fistula after previous surgery have 5-fold increased probability of impaired continence with additional procedures 5
• No surgical technique can regenerate the sensory corpus cavernosum tissue that was removed 2

Realistic Prognosis and Adaptation

The tissue loss is permanent, but quality of life can improve through neuroplastic adaptation, psychological intervention, and reframing of sexual experience. 1, 6

• Successful treatment of chronic pelvic pain conditions brings improvement in functioning and quality of life, even without restoration of original anatomy 1
• Response to pain therapy is associated with improved sexual function and concomitant improvements in quality of life 1
• Sexual function can be redefined and adapted through therapy, even with permanent anatomical changes 6
• Cognitive behavioral therapy and sex therapy can help develop alternative arousal pathways and satisfaction mechanisms 6

Critical Pitfalls to Avoid

• Do not pursue additional anorectal surgery—this will cause further damage 4, 5, 2
• Do not accept dismissal of your symptoms as "psychological"—they have a clear anatomical basis requiring specialized treatment 1, 6
• Do not delay psychiatric evaluation—the quality-of-life impact you describe requires immediate mental health intervention 1
• Do not expect tissue regeneration—treatment focuses on adaptation and central pain processing, not anatomical restoration 1, 6