Herniating embarrassment in the sac

Dear Dr. G,

I am a thirty-two-year-old man who noticed a very peculiar thing happening in my groin and hope to get some clarification from you about this.

It all started during the MCO, when all of us were stuck at home and had nothing much to do; I seized the opportunity and started a home gym as I was determined to keep fit and strengthen my muscles.

However, I noticed something popping from the left side of my groin when I was doing some lifting. I wasn’t sure what was going on, but it felt like something gave way.

Since then, I’ve noticed a persistent lump in my groin – especially after prolonged standing or heavy lifting. This lump isn’t painful, but it has been getting in the way when I have intercourse with my wife.

I have seen doctors for help, and was horrified when they told me I have a hernia and advised me to undergo an operation for it; I thought hernias only happen to old men and would like to put Dr G on the spot to seek his help.

What is a hernia and why is it happening to me? What do the doctors mean when they call it a “defect” and how will an operation repair it?

Will this affect my sex life?

Yours truly,

Embarrassed Ernest

A hernia occurs when an internal part of the body pushes through a weakness in a muscle. Various types of hernia can occur, usually involving the contents of a person’s abdomen. The most common type of hernias are groin hernia but other types include an umbilical hernia, a hiatus hernia and what is called a surgically-induced incisional hernia.

When it comes to the groin, hernias in this part of the body include the femoral and inguinal hernia with the latter being the commonest form of hernia when abdominal contents protrude through a natural orifice in the groin, namely inguinal canal.

In males, the route of the migration of the testes from the abdomen to the scrotum during the seventh month of gestation results in a point of weakness between the abdomen and thigh. However, in women, the remnant of the canal is much smaller as it does not accommodate structures such as the spermatic cord.

Therefore, men are many times more likely to have an inguinal hernia than women. An inguinal hernia can protrude directly or indirectly through the muscle wall, and this is known as either a direct or indirect hernia. The indirect hernia can also extend all the way to the scrotal sac, and this is called an inguinal scrotal hernia.

Early symptoms of inguinal hernia include a small bulge in one or both sides of the groin that increases in size and disappears when lying down. In men, an inguinal hernia also presents as a swollen or enlarged scrotum, as the abdominal contents may “drop” into the scrotum. The lump itself may result in discomfort or sharp pain, especially when straining, lifting, and during sexual intercourse.

Certain conditions raising the intra-abdominal pressure can precipitate the occurrence of inguinal hernia. The risk factors include obesity, heavy lifting, chronic coughing, straining with defecation or urination. The excess abdominal pressure results in the posterior wall of the inguinal canal giving way, and this leads to a protrusion of the abdominal contents such as the small intestine. Under normal circumstances, the protrusion of the abdominal organs is not life threatening, however strangulated bowels may present as a medical emergency.

There is currently no medical treatment for an inguinal hernia. Men may opt to wear a truss to hold back a reducible inguinal hernia within the abdomen. Having said that, surgical intervention is the only definitive solution for hernias. There are essentially two types of hernia repairs. Open hernia repair (herniorrhaphy) involves an incision in the groin, pushes back the content back, followed by the placement of synthetic mesh. Alternatively, laparoscopic intervention retracts and reduces the hernia and strengthens the weakness internally with a mesh. In both types of surgery, a synthetic mesh is usually used to strengthen the weakness. Although the mesh is strong enough to hold back a hernia, an unhealthy lifestyle can lead to a recurrence.

The complexity of the male reproductive system leaves men with some structural vulnerabilities even before birth, and this can be masked by healthy growth from childhood.

However, the added strains from an unhealthy lifestyle can aggravate the weakening process, and sadly the only remedy is surgical repair.

Healthy embarrassed men facing inguinal hernia repairs often put Dr. G on the spot for reasons of their weakness in the groin. His view is: “Admitting our own natural weakness in the groin may be important, and accepting a surgical helping hand for such vulnerability is often a necessity.”