According to the results of this study, age was the most important determinant of the IIEF score, which was aggravated by 25% from the first to the last assessment of the patients. There was a significant difference in erectile function immediately after surgery. Surgical technique and experience remain the main variables that determine the outcome, but other factors that may affect postoperative sexual function include patient age, preoperative sexual function, psychological adaptation to cancer diagnosis and co-morbidity (e.g. e.g., diabetes mellitus, hypertension). Other preoperative variables include the stage of the disease, maintenance of neurovascular links, urinary incontinence and adjunctive therapies such as hormone therapy and radiation [7,8].
Age has a significant effect on the recovery of erectile function in pelvic surgery, particularly post-prostatectomy, since there is a significant reduction in power erection with increasing age. Most series reported a 59–82% potency in patients under 60 years of age versus 36–57% of patients over 60 years of age [7] Kundu et al. reported that 40–50 year old patients who underwent bilateral nerve retention surgery have almost twice as much chance of regaining erections from patients over 70 years of age. Age is also correlated with the state of erectile function preoperatively, which has been reported to affect the recovery of erectile function[9]. Geary et al .[10] and Rabbani et al.[11] reported that pre-operative erectile function has a significant impact on the recovery of spontaneous erections. However, the average follow-up was only 12–24 months. In a study involving a follow-up of 1–3 years and 141 patients, it was found that at one year, 113/141 (80%) patients were sexually active, achieving vaginal contact (including medication) and 28 (20%) were sexually inactive. The reasons for sexual inactivity was incontinence (15/28, 53%), loss of interest in sex (10/28, 36%) and libido loss (3/28, 11%, hormonal therapy)[.7]
Regarding the educational level and its role in the sexual functioning of patients with pelvic surgery, it is likely that the higher educational level contributes to better sexual function, coupled with age and the absence of complications. In the Oudsten et al. study, it was found that sexually active participants were younger, employed and had a higher educational level than the participants who had no sexual activity.[4] Respectively, the findings of Sutsunbuloglu & Vural [12] showed that lower educational level was associated with greater sexual dysfunction.
Regarding the type of surgery in the present study, they were of open type, they were related to different pathological conditions (colectomy, prostatectomy , inguinal hernias etc.); the inguinal hernias accounted for one third of the interventions, while the number of prostatectomies was small. Indeed, hernia itself and hernia surgery may have an effect on sexual activity, however, the effect expected is smaller compared with other procedures and there may be significant improvement of sexual function. Ertan et al.[13] prospectively investigated 34 hernia patients in terms of sexual function before and 3 months after hernia repair using IIEF . They reported that there was a significant improvement in IIEF scores after recovery and that sexual activity was positively affected after surgery. Also, the age and overall health of the patient is another factor affecting rehabilitation time. It is known that younger patients recover faster than the elderly. Also, the older they are, the more co-morbidities exist, that do not facilitate rapid recovery and increase the likelihood of complications.