Hemorrhoidectomy Does Not Cause Erectile Dysfunction or Sexual Arousal Changes
Hemorrhoidectomy actually improves erectile function in men with pre-existing erectile dysfunction, rather than causing it. The available evidence demonstrates no mechanism by which hemorrhoid surgery would damage sexual function, and research shows the opposite effect—surgical treatment of hemorrhoids can enhance erectile performance.
Evidence Supporting Improvement in Sexual Function
A prospective study of 82 men with hemorrhoids and erectile dysfunction showed that the International Index of Erectile Function (IIEF) score increased significantly after hemorrhoidectomy, from 15.56 to 27.37 (p < 0.001), with 41.1% of patients experiencing improvement in erectile function compared to only 5.3% in the non-surgical control group 1
The improvement in erectile function after hemorrhoidectomy likely results from relief of chronic pelvic pain and discomfort that was interfering with sexual function, rather than any direct effect on erectile mechanisms 1
Anatomical and Physiological Considerations
Hemorrhoidectomy does not involve the autonomic nerves, blood vessels, or smooth muscle structures responsible for penile erection 2
Erectile function depends on intact cavernous nerves, adequate penile blood flow, and functional smooth muscle in the corpora cavernosa—none of which are affected by hemorrhoid surgery 2
The surgical field for hemorrhoidectomy is limited to the anal canal and does not extend to pelvic structures involved in sexual function 3, 4
Common Complications That Do NOT Include Sexual Dysfunction
Standard hemorrhoidectomy complications include bleeding (0.03-6%), urinary retention (2-36%), anal stenosis (0-6%), infection (0.5-5.5%), and fecal incontinence (2-12%), but sexual dysfunction is not among the recognized complications 3, 5
Approximately 10% of patients experience complications after hemorrhoidectomy, but these are limited to anorectal issues such as bleeding, fissure, fistula, abscess, stenosis, urinary retention, soiling, and incontinence—not erectile or arousal problems 3
Critical Distinction from Prostate Surgery
The evidence you may be confusing relates to prostate cancer surgery (radical prostatectomy), which commonly causes erectile dysfunction due to damage to the cavernous nerves that run alongside the prostate 6
Prostate surgery affects erectile function in the majority of men, with recovery dependent on nerve-sparing technique, patient age, and baseline function 6
Hemorrhoidectomy involves completely different anatomy and has no overlap with the neurovascular structures controlling erection 1, 3
Reassurance for Patients
Men considering hemorrhoidectomy should be counseled that the procedure will not impair their sexual function and may actually improve it if chronic pain has been interfering with sexual activity 1
The main postoperative concerns are pain management (requiring narcotic analgesics), time away from work (2-4 weeks), and standard surgical risks—not sexual dysfunction 3, 5
If a patient develops erectile dysfunction after hemorrhoidectomy, alternative causes should be investigated, as the surgery itself is not the etiology 1, 2