Possibilities of the strong posterior wall of inguinal canal in women.

Three hundred and twenty-nine females aged 15-81 years (mean 51.5 years) and 1,928 males aged 17-76 years (mean 42.9 years) who presented with inguinal hernia over a ten-year period were reviewed. Combined ipsilateral direct = indirect (pantaloon) hernia appeared only from the fourth decade in both sexes with 7 (1.8 pc) and 111 (5.6 pc) cases occurring in females and males respectively. 3.5 pc of the total herniae in females and 18.6 pc in males were of primary direct type. 40 (12.2 pc) females and 270 (14 pc) males had bilateral hernia. There was a marked rise in the incidence of primary direct and bilateral hernia in males from the fourth and fifth decades. It is postulated that this is because defective collagen synthesis in the tissues of the inguinal region occurs more in males than in females.