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Beyond Incontinence: A Systematic Review and Meta-Analysis of Sexual Dysfunction after Anal Fistula Surgery.

Pankaj Garg1, G Mahak2, Prema Ram Choudhary3

  • 1Chief Colorectal Surgeon, Garg Fistula Research Institute, Panchkula, Haryana, 134113, India.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|July 2, 2026
PubMed
Summary

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Anal fistula surgery significantly impacts sexual function differently in men and women. Chronic seton use impairs female sexual function and body image, necessitating improved informed consent.

Area of Science:

  • Colorectal Surgery
  • Sexual Medicine
  • Psychosocial Health

Background:

  • Traditional anal fistula surgery metrics overlook sexual function and psychosocial well-being.
  • A critical literature gap exists regarding gender-specific impacts of fistula surgery on sexual health.

Purpose of the Study:

  • To systematically review and meta-analyze the gender-specific effects of anal fistula surgery and seton placement on sexual function.
  • To quantify the impact on male and female sexual function using validated indices.

Main Methods:

  • A PRISMA-compliant systematic search of major databases (PubMed, Embase, Scopus, Cochrane).
  • Inclusion of studies using validated sexual indices (IIEF for males, FSFI for females) and quality-of-life surveys.
  • Pooling of continuous pre- and postoperative functional data using Standardised Mean Differences (SMD).
Keywords:
Anal FistulaPerianal Crohn’s DiseaseQuality of LifeSetonSexual DysfunctionSystematic Review

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Main Results:

  • Eighteen studies revealed significant gender dimorphism in surgical recovery.
  • Male sexual function (IIEF) improved significantly post-surgery, while female sexual function (FSFI) showed little improvement or deterioration, often with dyspareunia.
  • Chronic seton use ('Seton Paradox') significantly impaired female sexual function (p=0.02) and led to body-image avoidance.
  • A systemic failure in informed consent was noted, with 79% of patients not receiving pre-operative sexual counselling.

Conclusions:

  • Anal fistula surgery has a profound, gender-dimorphic effect on sexual function.
  • Chronic setons impose a significant psychological burden and impair sexual health.
  • Mandatory preoperative counselling on sexual function, body image, and intimacy is required.