The genitofemoral nerve divides into a genital branch that enters the inguinal canal and supplies the cremaster muscle and scrotal skin, and a femoral branch that exits through the femoral sheath to supply a small patch of upper anterior thigh skin. It is the nerve responsible for the cremaster reflex (stroking the inner thigh produces ipsilateral scrotal elevation). Genitofemoral neuralgia from retroperitoneal surgery, laparoscopy, or inguinal hernia repair produces groin and scrotal pain.
| Origin | Lumbar plexus (L1, L2) |
|---|---|
| Course | Passes through the psoas major, descends on its anterior surface, and divides at the inguinal ligament into the genital branch (through the inguinal canal) and femoral branch (through the femoral sheath) |
| Motor |
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| Sensory |
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The genitofemoral nerve lies on the front of psoas behind the peritoneum and ureter, so it is at risk during laparoscopic inguinal hernia repair (TAPP and TEP), retroperitoneal surgery such as lymph node dissection, lumbar sympathectomy and lateral transpsoas spine surgery. Injury produces burning groin, scrotal or labial and upper anterior thigh pain, part of the chronic post-herniorrhaphy groin pain syndrome; refractory cases may need neurectomy as part of a triple neurectomy.
Groin and scrotal burning from nerve injury during laparoscopic hernia repair or retroperitoneal surgery, managed with nerve block and included in triple neurectomy for inguinal neuralgia.
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