What should I do next to address my sexual dysfunction after anal surgery, given that my current providers don't seem to understand my condition and I'm considering paying out of pocket for an ultrasound?

Navigating Care for Sexual Dysfunction After Anal Surgery

You should seek evaluation from a pelvic floor specialist or sexual medicine expert who has specific experience managing sexual dysfunction after anorectal surgery, as this is a recognized complication that requires specialized assessment and treatment. 1

Understanding Your Condition

Sexual dysfunction after anal surgery is a well-documented complication that affects a significant proportion of patients:

• Approximately 47.4% of patients who regularly engaged in anal intercourse preoperatively abandon this practice after proctologic surgery, with the most common complaints being pain, stiffness, and partner discomfort 2
• Sexual dysfunction following pelvic surgery is multifactorial and can include decreased libido, pain with intercourse, decreased genital sensation, and difficulty achieving orgasm 3
• The surgeon has a duty to both treat the disease and inform patients about possible consequences regarding sexual function, though this discussion often does not occur adequately 2, 4

Immediate Steps to Take

1. Seek Specialized Evaluation

Request a referral to a urologist or urogynecologist who specializes in sexual medicine, as these specialists have specific training in managing post-surgical sexual dysfunction 1:

• Use validated assessment tools such as the Sexual Health Inventory for Men (SHIM) or Female Sexual Function Index (FSFI) to objectively document your dysfunction 1, 4
• Assessment should include evaluation for psychological factors contributing to dysfunction, including anxiety about performance after surgery 1

2. Consider Diagnostic Imaging

If you're considering paying out-of-pocket for an ultrasound:

• Transvaginal or transperineal ultrasound can assess for anatomic abnormalities, scar tissue, or structural changes that may be contributing to sexual dysfunction 5
• Ultrasound can evaluate pelvic floor muscle morphology and identify structural complications from surgery 5
• However, ensure this imaging is ordered by a specialist who can interpret the findings in the context of post-surgical sexual dysfunction 5

3. Pursue Comprehensive Assessment

A thorough evaluation should include 1:

• Physical examination focusing on the surgical site, scar tissue, vaginal/anal caliber, and pelvic floor muscle function 6, 3
• Assessment for complications such as stricture formation, which typically develops within one year of surgery 7
• Evaluation for pain, decreased sensation, or anatomic changes affecting sexual function 2, 3

Treatment Options Based on Your Specific Issues

For Pain During Intercourse

• Pelvic floor physical therapy with specialized therapists trained in post-surgical rehabilitation 1
• Vaginal moisturizers and water or silicone-based lubricants 5
• Assessment for and treatment of any surgical complications like strictures or excessive scarring 7, 3

For Decreased Sensation or Function

• Referral to a sexual medicine specialist for comprehensive management 1
• Individual or couples counseling to address relationship and intimacy issues 1
• Partner involvement in treatment decisions is essential for improving outcomes 1

For Psychological Distress

• Assessment for depression/anxiety using screening tools like the Distress Thermometer 1
• Cognitive behavioral therapy may be beneficial for addressing sexual concerns 1
• Recognition that sexual dysfunction is correlated with greater psychosocial distress 5

Finding Resources in Your State

Specialist Referral Pathways

• Contact academic medical centers or university hospitals in your state, as they typically have pelvic floor specialists and sexual medicine experts 1
• Look for urogynecology or colorectal surgery centers that specifically advertise expertise in post-surgical complications 5
• Consider telehealth consultations with specialists from other states if local resources are limited 1

Support and Advocacy

• Patients with post-surgical sexual dysfunction often report that their concerns are dismissed or inadequately addressed, but this is a recognized medical complication requiring treatment 4
• Document your symptoms using validated questionnaires (FSFI or SHIM) to provide objective evidence of dysfunction 1, 4
• Request that your current provider refer you to appropriate specialists, emphasizing that sexual dysfunction after pelvic surgery is a documented complication requiring specialized care 2, 4

Important Considerations

Timing of Intervention

• Many patients continue to experience improvement in sexual function for up to 1-2 years after surgery, so early intervention with rehabilitation protocols may help preserve function 5, 1
• However, persistent symptoms beyond 6-12 months warrant aggressive evaluation and treatment 6

Common Pitfalls to Avoid

• Do not accept dismissal of your concerns as "normal" or "expected" - while sexual dysfunction is common after anal surgery, it requires evaluation and treatment 2, 4
• Avoid assuming that imaging alone will solve the problem; comprehensive assessment by a specialist is essential 5, 1
• Do not delay seeking specialized care, as early intervention may improve outcomes 1

Quality of Life Priority

• Sexual dysfunction significantly impacts quality of life and deserves the same attention as other surgical complications 5
• Studies show that patients seldom remember discussing sexual risks preoperatively and are rarely treated for dysfunction, but this represents a gap in care that should be addressed 4
• Your concerns are valid and warrant comprehensive evaluation and treatment by specialists experienced in managing post-surgical sexual dysfunction 1, 2