Association Between Hemorrhoidectomy and Sexual Dysfunction: A Prospective Case-Control Study Using the Natsal-SF Scale

Purpose: Haemorrhoidectomy is a common surgical treatment for advanced haemorrhoidal disease, but its potential impact on postoperative sexual function is underexplored. This study aimed to evaluate the association between haemorrhoidectomy and short-term sexual dysfunction using the validated, gender-inclusive Natsal-SF scale. Methods: This was a prospective, case-control study conducted at a tertiary referral centre. Forty adults with symptomatic hemorrhoidal disease were included: 20 underwent haemorrhoidectomy (cases) and 20 received conservative medical management (controls). The main outcome was sexual dysfunction at 30 days post-intervention, defined as reporting problems in ≥2 items of the Natsal-SF questionnaire. Associations were analysed using univariate and multivariate methods. Results: Sexual dysfunction was significantly more frequent in the haemorrhoidectomy group compared to controls (85% vs. 25%, p<0.002). The most affected domains were physiological function—including erectile or lubrication difficulties (70%)—and overall sexual satisfaction (60%). After adjusting for age, sex, immunosuppression, psychiatric history, and haemorrhoid grade, the association remained statistically significant (p=0.023). Conclusion: Haemorrhoidectomy is associated with a high incidence of early postoperative sexual dysfunction. The Natsal-SF, a comprehensive and inclusive tool, was effective in identifying this frequently neglected outcome. Preoperative counselling for haemorrhoidectomy should address potential sexual side effects.