Muscle and Nerves

Cremasteric Muscle

The cremasteric muscle starts at the internal inguinal ring and runs down to the testicle. During intercourse and when cold, the cremasteric muscle contracts and pulls the testicle up. But the cremasteric muscle can add a significant amount of bulk to the spermatic cord. Some surgeons routinely advise removing the cremasteric muscle to make the spermatic cord smaller and thereby allowing a tighter closure of the internal ring. But then the testicle will not rise and fall as it should. Also, important blood vessels and nerves travel with the cremasteric muscle. Dr. Brown does not want to compromise the testicle in any way, and therefore does not remove the cremasteric muscle.  

Nerves

There are three major nerves in the inguinal area. The iliohypogastric nerve, the ilioinguinal nerve, and the genital nerve. The iliohypogastric nerve provides sensation to the pubic hair area and the upper part of the scrotum or Mons. The ilioinguinal nerve provides feeling to the inguinal ligament, on the inside of the upper thigh, and the outside of the scrotum or Mons. The genital nerve provides innervation to the cremasteric muscles and the testicle or labia majora. Damage to any of these nerves can cause chronic pain after the surgery. Some surgeons advise routine transection of these nerves to avoid postoperative pain. But cutting the nerves causes the skin to be numb. And if the damaged nerve forms a neuroma, then the patient suffers allodynia. Dr. Brown feels it is best to carefully identify the nerves during the operation. And then he takes care not to damage the nerves. The iliohypogastric nerve runs parallel to the inguinal ligament and deep to the external oblique aponeurosis. It will emerge through a hole in the external oblique aponeurosis just above the external inguinal ring and continue its journey to the skin. 

The ilioinguinal nerve joins the spermatic cord (or round ligament in women) at the internal inguinal ring and then runs along the anterior superior aspect of the spermatic cord (or round ligament).  The genital nerve usually joins the spermatic cord (or round ligament) at the internal inguinal ring. It then runs along the posterior aspect of the spermatic cord (or the round ligament). Of the three nerves, the course of the genital nerve is the most variable. Instead of traveling with the spermatic cord (or round ligament), it can be found near the inguinal ligament or running along the floor of the inguinal canal.

Learn more about Dr. Brown’s approach to hernia repair without mesh. Contact Dr. Brown today.