In a patient with chronic anal fissure previously treated with lateral internal sphincterotomy, hemorrhoidectomy and fissurectomy three years ago (complicated by constipation) and a low trans‑sphincteric fistulotomy involving less than 30 % of the external sphincter performed seven months ago with revision, now experiencing persistent deep‑pelvic sexual arousal loss and reduced urinary awareness, what is the most likely diagnosis and the appropriate first‑line management?

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In a patient who underwent lateral sphincterotomy, hemorrhoidectomy/fissurectomy, and a low trans‑sphincteric fistulotomy with revision, now has new‑onset loss of deep pelvic sexual arousal and reduced urinary sensation despite normal pudendal nerve pin‑prick testing and no pain, what is the likely cause and appropriate management?

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