Inability to ejaculate

[cms9375]

I had surgery for an inguinal hernia in July 2007.  Since then, I have had problems ejaculating. Could this be a  complication  of the surgery?  If so, is there a fix?  Would this prevent my wife and I from being able to have children?

Please advise.

[Dr Smitha Mathews]

Hi,
damage to any of the spermatic structures or nerve injury during the surgery may have contributed to the problem.

"Iatrogenic decrease in fertility potential has also been reported in patients who have undergone inguinal surgery, most commonly herniorrhaphy Ischemic atrophy of the testis is rare in primary repairs (less than 1%) but occurs in 5% of recurrent hernia repairs.3 Vasal obstruction, either by transection or more often compression of the inguinal vas, is far more common than vascular insult. Vasal transection is rare and, if recognized, may be treated with immediate microsurgical reconstruction. Vasal compression may result from improper intraoperative handling, improper mesh placement or delayed fibrosis of the mesh. To date no long-term studies on adult mesh hernia repair have investigated the effect of mesh on the inguinal vas, although case reports of inguinal obstruction from mesh herniorrhaphy have been published.4 Unfortunately attempts at vasal reconstruction are frequently futile secondary to extensive mesh related fibrosis and resultant devascularization of the vas"

"Unless the vasal defects are inordinately long, inguinal exploration and microsurgical reconstruction can be accomplished in the majority of cases. Because many of these patients have had long-standing obstruction, some may also require concomitant scrotal vasoepididymostomy for secondary obstruction"
www.maleinfertility.org/new-aua2003.html

You will need to consult a urologist to identify the cause of the anejaculation.
Sometimes a weak bladder neck can also cause the semen to flow back instead of out.

Do keep us posted on your doubts and progress.
Regards