Hemorrhoidectomy, Fissurectomy, and Lateral Sphincterotomy Do Not Typically Cause Reduced Libido, and Your Prognosis for Recovery is Excellent
The anorectal procedures you underwent (hemorrhoidectomy, fissurectomy, and lateral sphincterotomy) are not known to directly cause decreased libido in males, and since you maintain erectile and orgasmic function, your prognosis for spontaneous recovery is very favorable.
Understanding the Disconnect Between Your Symptoms and These Procedures
The procedures you underwent target the anal canal and internal anal sphincter, which are anatomically and neurologically distinct from the structures governing libido and erectile function:
Hemorrhoidectomy has actually been shown to improve erectile function in men with hemorrhoids and ED, with one study demonstrating IIEF scores increasing from 15.56 to 27.37 post-operatively (p<0.001), with 41.1% of patients showing improvement 1
Lateral sphincterotomy studies show preserved or improved sexual function in the vast majority of patients, with 74.8% reporting unchanged or improved erections, and 96.1% maintaining their preoperative sexual ability 2
These procedures do not involve the neurovascular bundles that control penile erection (cavernosal nerves) or the hormonal pathways that regulate libido 3
What Actually Causes Reduced Libido vs. Erectile Dysfunction
Your presentation—preserved erections and orgasms but reduced spontaneous desire—suggests a libido issue rather than erectile dysfunction, which is a critical distinction:
Libido is primarily regulated by testosterone levels and psychological factors, not by pelvic nerve integrity 4
Erectile dysfunction from nerve damage (as seen in prostate or rectal cancer surgery) presents differently: patients lose the mechanical ability to achieve erections, not just the spontaneous desire 3, 5
Your ability to achieve erection and orgasm indicates intact neurovascular pathways, making surgical nerve injury extremely unlikely 4
Most Likely Alternative Explanations for Your Symptoms
Psychological and Recovery-Related Factors
Post-surgical pain, anxiety about recurrence, and body image concerns commonly affect sexual desire after anorectal procedures, even when mechanical function is preserved 4
The recovery period itself (typically 4-6 weeks for complete healing) can suppress libido through pain, discomfort, and fear of disrupting surgical sites 6
Hormonal Factors to Investigate
Check morning testosterone levels: If <300 ng/dL, testosterone deficiency could explain isolated libido reduction while preserving erectile function 7
Testosterone therapy may restore libido if levels are low, though this requires formal evaluation 4, 7
Your Prognosis for Recovery
Your prognosis is excellent based on the following factors:
Preserved erectile and orgasmic function indicates no structural or neurological damage from your surgeries 1, 2
Spontaneous libido typically returns as post-surgical pain resolves, anxiety diminishes, and normal activity resumes (usually within 3-6 months post-operatively) 4
Studies of anorectal surgery show no long-term libido impairment when erectile function is preserved 1, 2
Recommended Management Approach
Immediate Steps
Rule out testosterone deficiency with morning serum testosterone measurement; if <300 ng/dL, consider testosterone replacement therapy 7
Assess for depression and anxiety, which commonly suppress libido and may be exacerbated by surgical recovery 4
Ensure complete surgical healing before expecting full return of sexual function (typically 4-6 weeks minimum) 6
Supportive Interventions
Lifestyle optimization: smoking cessation, weight loss, increased physical activity, and reduced alcohol consumption all enhance sexual function 7
Consider psychosexual counseling if distress persists beyond 3-6 months, as psychological factors may be maintaining reduced desire 4, 7
Pelvic floor physical therapy may improve overall pelvic comfort and sexual function after anorectal surgery 7
Critical Pitfalls to Avoid
Do not assume your symptoms are permanent or directly caused by the anorectal procedures—the evidence strongly suggests otherwise 1, 2
Do not confuse reduced spontaneous desire with erectile dysfunction—these require different evaluations and treatments 4
Do not delay testosterone evaluation if libido remains suppressed beyond 3-6 months, as hypogonadism is a treatable cause of isolated libido reduction 7