Where is the ENTRANCE to Alcock's Canal?

[A's Mommy]

My husband and I have been over and over this.... and can't come to a conclusive answer. Where is the ENTRANCE to the Alcock's Canal? Say you are starting at the nerve Roots, S2-S4 and travel down through the piriformis, etc, and then enter the obturator fascia, would THIS be the entrance... or would the "entrance" be from the opposite side.... after the nerve branches off into the smaller branches? Beco's diagram confuses me. I know everyone's "branches" are in different places, but this question still puzzles me and should be an easy one to answer. I was wondering if anyone could give insight.

TY,

AM

[ezer]

Here is Beco's drawing. I thought the entrance is right above number 3:

[Pelvis Stressly]

Personally, I like the illustration I've attached (I refer to it often...you can find it in the anatomy section of this site). The Alcock's Canal is the transparent 'sheath' looking thing that they have labelled as the 'pudendal canal'.

Here are my PT's comments on the question of variations in anatomy re. the course of the pud. nerve (particularly w. regards to where branching happens)...

"Okay, there are three proposed courses of the pudendal nerve. controversy exists in what the "normal" course is, and there are anatomical variations. The main variation is where does the dorsal brach and inferior rectal branch come off>

Course One: All three brances split off in the perineum after Alcock's Canal.

Course Two: Dorsal branch splits off before Alcock's canal and the other two after.

Course Three: The Rectal branch splits off before Alcock's canal [*as shown in the illustration I've attached] and the other two after.

Jury is out. I have not read anything definite and conclusive."

Hope that helps,
PS.

[A's Mommy]

Thank you PS!!! I have looked at these pics numerous times.

PS: What's your next line of action?

[drds89]

My impression is what ezer says just above 3 on Beco's drawing and on the image in the next post, the 'entrance' would be at the clear looking sheath structure right after the inferior rectal branch takes off--then you're 'entering' Alcock's canal.

[Lernica]

Please excuse my ignorance, but are there two Alcock's canals, one on each side of the body? Or are the nerves joined as one at that point?

[JeanieC]

Hi Lernica,

Yes, there are 2 alcock's canals, one in each buttock

[Pelvis Stressly]

PS: What's your next line of action?

Not sure yet, to be honest. Was all set to head down to see Dellon, but I went to see one last urologist here first (who specializes in ED). He re-did my Doppler test (which measures blood flow in the penis), and the results were totally normal. He also said the test rules out any sort of neurogenic component! His reasoning for that was, even after he administered the intracavernous injection (medication which induces an erection, for the sake of the test), I failed to achieve a full erection. He said if my problem was neurogenic, I would have achieved one (as the medication bypasses the neurotransmitters).

He said, by order of elimination, it has to therefore be one of two things...either a venous leak (where blood is flowing healthily into the penis, but then, due to a leak, isn't being held there properly), or it's due to stress/anxiety (causing the muscles to tense, thus preventing the blood from properly dispersing into a full erection...a la "A Headache in the Pelvis"). He believes it's the latter and wants me to explore that area more. I'm skeptical, mainly because I feel like I've already gone down that road (shrinks, yoga, meditation, physio, etc.), but will give it a shot.

What I'm really trying to confirm at the moment is his claim that the intracavernous injection (& the fact that I didn't get a full erection from it) offers indisputable proof that there isn't any neuropathy involved. And if so, why no one told me that sooner (I've had similar injections, w. identical results, numerous times over the last few years)!!!!

How are things w. you? Post-surgery zaps starting to go down at all yet?