Beyond incontinence: a systematic review and meta-analysis of sexual dysfunction after anal fistula surgery.

Cross-sectionalJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract· Jul 2026

Beyond incontinence: a systematic review and meta-analysis of sexual dysfunction after anal fistula surgery.

Pankaj Garg, G Mahak, Prema Ram Choudhary … Vipul D Yagnik

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Colon & Rectal SurgeryCross-sectionalClinical practiceQ2IF 2.0

79% of patients never received preoperative counseling on sexual dysfunction before anal fistula surgery.

Beyond incontinence: a systematic review and meta-analysis of sexual dysfunction after anal fistula surgery.

Pankaj Garg … Vipul D Yagnik

Journal of gastrointestinal surgery · Jul 2026 · Q2 in Gastroenterology

Background

Traditional metrics for anal fistula surgery prioritize healing and continence, largely ignoring intimacy and psychosocial well-being.

Methods

A Preferred Reporting Items for Systematic Reviews and Meta-Analyzes-compliant search of PubMed, Embase, Scopus, and Cochrane databases identified studies using validated sexual indices: International Index of Erectile Function (International Index of Erectile Function) for males and the Female Sexual Function Index (Female Sexual Function Index), and targeted quality-of-life surveys for cryptoglandular or Crohn's-associated fistulas.

n = 18 studies

Results

79%

most patients weren't told surgery could affect their sex life beforehand

n = 18 studies

More results

The systematic review established a stark, previously unquantified sex dimorphism in surgical recovery.

Definitive surgical cure yielded highly significant improvements in International Index of Erectile Function (male) by eradicating chronic suppuration (P <.001).

More results

Conversely, Female Sexual Function Index (female) showed negligible improvement or active deterioration, frequently complicated by anterior-tract dyspareunia.

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Conclusion · 1 of 3

Anal fistula surgery inflicts a profound, sex-dimorphic toll on sexual function.

Conclusion · 2 of 3

As the first systematic review to objectively highlight this disparity and quantify the psychological burden of chronic setons, these findings mandate a clinical paradigm shift.

Conclusion · 3 of 3

Proactive counseling regarding dyspareunia, body image, and intimacy must become a mandatory component of preoperative informed consent.

Beyond incontinence: a systematic review and meta-analysis of sexual dysfunction after anal fistula surgery.

Beyond incontinence: a systematic review and meta-analysis of sexual dysfunction after anal fistula surgery.

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