What nerves travel through the inguinal canal in men?

Nerves Traveling Through the Inguinal Canal in Men

The three main nerves that travel through the inguinal canal in men are the ilioinguinal nerve, the iliohypogastric nerve, and the genital branch of the genitofemoral nerve. 1, 2, 3

Anatomical Course and Identification

Ilioinguinal Nerve

• Runs ventrally and parallel to the spermatic cord, positioned dorsally (posterior) to the external oblique aponeurosis 2
• Travels through the entire length of the inguinal canal alongside the spermatic cord 1
• Can exhibit significant anatomical variation, including acute infero-lateral angulation at its exit behind the superficial inguinal ring in some cases 4

Iliohypogastric Nerve

• Runs approximately horizontally and ventrally to the internal oblique muscle 2
• Perforates the external oblique aponeurosis at a mean of 3.8 cm (range 2.5-5.5 cm) cranially from the external inguinal ring 2
• May travel in a more superficial plane than typically described in up to 18% of cases 4

Genital Branch of the Genitofemoral Nerve

• Follows a laterocaudal course at the level of the internal inguinal ring 2
• Travels within the spermatic cord structures 1
• Is the most difficult of the three nerves to identify during surgery, with identification rates around 52.6% 1

Clinical Significance During Surgery

Identification and preservation of all three nerves during inguinal hernia repair significantly reduces chronic postoperative pain. 3

• Failure to identify nerves correlates with increased risk of chronic pain, with risk escalating proportionally to the number of unidentified nerves 3
• Division of identified nerves is clearly associated with chronic pain development 3
• All three nerves can be identified simultaneously in approximately 52.6% of cases during open inguinal hernia repair 1

Anatomical Variations and Pitfalls

Anatomical variations occur in 58.2% of cases, making standard textbook anatomy unreliable for surgical planning. 4

Common variations include:

• A single common stem for both the ilioinguinal and iliohypogastric nerves over the spermatic cord (24 out of 64 variant cases) 4
• Acute infero-lateral angulation of the ilioinguinal nerve at the superficial inguinal ring exit 4
• Absence of one or both nerves in approximately 8% of variant cases 4
• Aberrant origin of the ilioinguinal nerve from the genitofemoral nerve in rare cases 4
• Previous hernia repair significantly interferes with ilioinguinal nerve identification 1