Is a splenectomy (removal of the spleen) the primary cause of altered sensations, including sexual dysfunction, in a patient with a history of cauterization, fissurectomy, internal hemorrhoidectomy, and lateral internal sphincterectomy?

Splenectomy and Altered Sexual Sensations

The altered sexual sensations your patient is experiencing are most likely directly caused by the splenectomy itself, not the anorectal procedures (cauterization, fissurectomy, internal hemorrhoidectomy, and lateral internal sphincterectomy). A recent 2021 study demonstrated that asplenia is independently associated with marked decreases in libido and intense sexual dysfunction in both men and women, even when all laboratory parameters including sex hormones remain completely normal 1.

Evidence for Splenectomy-Related Sexual Dysfunction

The most compelling evidence comes from a controlled study of 60 healthy adults (30 men, 30 women) who underwent total splenectomy for isolated splenic trauma 1. This study design is particularly relevant because:

• Each patient served as their own control, comparing pre- and post-splenectomy sexual function 1
• All patients had normal hematological, biochemical, and hormonal laboratory values post-operatively, yet still experienced sexual dysfunction 1
• 100% of both men and women demonstrated decreased libido and increased sexual dysfunction after splenectomy (p < 0.001) 1
• The study specifically excluded confounding factors by studying patients with isolated splenic trauma rather than complex medical conditions 1

Why Splenectomy Affects Sexual Function

The mechanism remains incompletely understood, but the sexual dysfunction occurs despite:

• Normal testosterone, estrogen, and other sex hormone levels 1
• Normal complete blood counts 1
• Normal metabolic panels 1
• Time elapsed of more than 1 year post-surgery (ruling out acute surgical effects) 1

This suggests the spleen plays an unrecognized role in sexual function regulation that is independent of hormonal pathways currently measured in standard laboratory testing 1.

Why the Anorectal Procedures Are Less Likely Responsible

While the patient's history includes multiple anorectal procedures, these are unlikely to be the primary cause because:

• Lateral internal sphincterectomy and hemorrhoidectomy do not typically affect genital sensation or sexual arousal pathways (these procedures target the anal sphincter complex, not pelvic autonomic nerves)
• Sexual dysfunction after pelvic surgery is typically related to nerve injury during radical procedures like radical hysterectomy, not minor anorectal surgery 2
• The patient's sexual dysfunction pattern (altered sensations including sexual function) matches the documented post-splenectomy syndrome rather than the localized pain or dyspareunia expected from anorectal procedures 1

Clinical Implications and Management

There is currently no established treatment for post-splenectomy sexual dysfunction 1. However, you should:

• Validate the patient's symptoms as a recognized complication of splenectomy rather than dismissing them as psychological 1

• Rule out other contributing factors including:

  • Depression or body image issues (which can be addressed with counseling) 2
  • Medication side effects from any drugs the patient is taking 2
  • Complications from the anorectal procedures such as chronic pain or fecal incontinence that might secondarily affect sexual function

• Consider referral to sex therapy or counseling to help the patient cope with these changes, even though the underlying cause is organic 2

• Assess for other post-splenectomy complications that might compound the problem, including:

  • Thromboembolic events (which occur at 3-4 fold higher rates post-splenectomy) 2
  • Chronic infections that could affect overall well-being 3
  • Metabolic disturbances including dyslipidemia 1

Important Caveats

• This is an emerging area of research with limited data; the 2021 study is the first to systematically document this phenomenon in humans 1
• The sexual dysfunction appears to be permanent based on the study's follow-up period of more than 1 year 1
• Patients should have been counseled about this risk before elective splenectomy, though this complication is not yet widely recognized in surgical consent processes 1