Spermatic Cord and Vasectomy

Are you getting a vasectomy?
Plan ahead and get some cold packs on Amazon and a 3 pack of jock straps for a comfortable post-surgery recovery!

After vasectomy, your testicles will hang (and move) the same way they did before. It’s true many diagrams suggest the vas deferens are the only things connecting our testicles to the rest of us. But in fact, the vas tubes are just one part of a complicated group of structures called the spermatic cord, which is not severed during vasectomy.

A diagram of the spermatic cordThese structures include arteries and veins circulating blood to and from the testes and other structures in the scrotum. This is also how testosterone made in the testicles is circulated throughout the body. The cremasteric muscles, which cause your testicles to pull up when you are cold or anxious (like on the doctor’s table), or about to ejaculate. Bunches of nerves, lymphatic vessels, and other stuff.

It is these structures together that support the testicles in the scrotum. The vas deferens are thin, hard tubes mixed up in all of this, and they are the only things cut during vasectomy.

One challenge doctors face before vasectomy is separating the vas tubes from the rest. They usually do this first at a pre-vasectomy consult (the “tube check”), when they confirm your tubes are easy to locate and that the feel of them doesn’t suggest any special problems. They do it again during the vasectomy itself before cutting.

Description of spermatic cord, its layers and contents

Definition: The spermatic cord is a collection of structures that pass through the deep inguinal ring and the fascial coverings contributed by the layers of the abdominal wall

Function: The function of the spermatic cord is to suspend the testis in the scrotum and contain structures running to and from the testis

Embryology: The spermatic cord is derived from processus vaginalis; the spermatic cord and its contents are derived from lateral plate and intermediate mesoderm.

Relationships

  • Begins at the deep inguinal ring, lateral to the inferior epigastric vessels.
  • Passes through the inguinal canal.
  • Exits at the superficial inguinal ring.
  • Ends in the scrotum at the posterior border of the testis.

Description

Coverings of the spermatic cord:

  • Tunica vaginalis covers the anterior surface of the spermatic cord just above the testis
  • Internal spermatic fascia (transversalis/endoabdominal fascia)
  • Cremasteric fascia (fascia of internal oblique muscle)
  • External spermatic fascia (aponeurosis of the external oblique muscle)
  • The cremasteric fascia contains loops of cremasteric muscle, which draws the testis superiorly in the scrotum when it is cold.

Constituents of the spermatic cord

  • Ductus deferens (conveys sperm from the epididymis to the ejaculatory duct)
  • Arteries
  • Testicular artery (arises from the abdominal aorta at L2)
  • Artery of the ductus deferens (arises from inferior vesical artery)
  • Cremasteric artery (arises from the inferior epigastric artery)
  • Veins
  • Pampiniform plexus (formed by up to 12 veins, drain into right and left testicular veins)
  • Nerves
  • Sympathetic nerve fibers on arteries
  • Sympathetic and parasympathetic nerve fibers on the ductus deferens
  • Genital branch of the genitofemoral nerve supplying the cremaster muscle
  • Lymphatics
  • Lymphatic vessels draining the testis and closely associated structures
  • lumbar lymph nodes

Further Reading and Illustrations

Spermatic cord cross section – AAFP

Page from the American Academy of Family Physicians called “Diagnosis and Treatment of the Acute Scrotum”. It has an excellent cross sectional diagram of the normal testicle and spermatic cord.

Spermatic cord cross section #2

Diagrams of the inigual region, including explanations and cross sections of the spermatic cord

 

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