The groin is located where the upper thighs meet the lower abdomen, on either side of the pubic bone. Many medical conditions can cause pain in this area in women.
Groin pain sometimes signals a recent injury to the area and often resolves within a few weeks. Athletes are at risk for more progressive chronic (long-term) groin pain from overuse injuries. Osteoarthritis is another potential cause of chronic groin pain.
Less commonly, groin pain signals a more urgent condition, such as a urinary or reproductive system problem. Severe or additional symptoms, such as a fever, are signs that you may need emergency medical attention.
The anatomy of the groin itself is complex, and the surrounding organs can also sometimes cause pain in this region. Some important landmarks to understand are:
- Abdominal wall muscles: The external obliques, internal obliques, and transversus abdominis muscles pass through this area.
- Inner thigh and hip muscles: Important muscles include adductor longus, adductor brevis, iliopsoas, pectineus and gracilis. Each of these muscles also connects to a tendon, so tendon strains and tendonitis can be other sources of pain.
- Hip joint: The ilium, ischium, and pubic bones come together and meet the femur (thigh bone) to help you move your hip.
- Reproductive organs: In women, there are ovaries in the abdomen, from which eggs are released during ovulation. Slender tubes called fallopian tubes connect the ovaries to the uterus (womb), where the embryo grows.
- Urinary organs: Urine travels from the kidneys (at the back of the body) to the bladder and finally through the urinary opening.
- Digestive organs: Important abdominal organs include the large intestine, which helps in the final stages of faecal elimination, and the appendix, a short, elongated large intestine.
The specific nature of groin pain and associated symptoms can help a healthcare professional identify potential causes.
A sudden muscle strain or other injury
One common injury is a muscle strain or pull, which can happen when a muscle is overstretched and partially torn. Such injuries often occur during running, jumping or high-speed sideways activities.
In the case of a pulled muscle, you will likely notice pain and injury immediately and may hear a popping sound. Depending on the severity, you may also develop bruising and swelling in the area. In addition to groin pain, you may have difficulty lifting your leg or moving your leg closer to the midline.
Other injuries are also possible, such as a fracture of one of the femurs or pelvis or damage to the surrounding tendons, ligaments and nerves.
Chronic muscle injury (athletic pubalgia)
Professional and amateur athletes are especially prone to the type of chronic groin pain sometimes called “athletic.” pubalgia,” “groin pain syndrome” or “sports hernia” (although not a hernia). Such injuries are common in sports that require rapid acceleration and turns and heavily use the lower abdominal and thigh muscles, such as football.
In athletic pubalgia, the pain develops gradually over several months. At first it can be sudden and intense, then dull or burning. The pain is usually deep in the groin, but can also be felt in the lower abdomen and inner thigh.
Sudden acceleration, twisting, cutting motions, sit-ups, and coughing can make the pain worse. The pain usually goes away after rest, but it returns if you continue to play sports without proper care.
Urinary system problems
A urinary tract infection (UTI) can cause pressure or cramping in the groin or lower abdomen. Due to differences in anatomy, women are much more at risk of such infections compared to men. A UTI can also cause pain during urination, and you may need to urinate more often.
If you have a fever and the pain starts to radiate down your sides and back, it may signal a more serious type of infection that has reached the kidneys (pyelonephritis).
Kidney stones are gravel-like materials that form in the kidneys and cause pain when they enter the urinary tract. They can cause bloody urine and sometimes severe, sharp pain, which you may feel in your lower abdomen, back, side or groin.
Arthritis of the hip
Hip arthritis is a potential cause of groin pain that tends to flare up during vigorous activity, but can also occur at rest. You may feel pain in your groin that radiates (moves) down to your knees or into your buttocks.
Stiffness in the joint can make it difficult to walk and limit your range of motion. You may also notice that the joint locks and you hear a creaking sound during movement.
Osteoarthritis, in which the cartilage in the hip joint wears down and degenerates over time, is the most common cause of hip arthritis. It is more common with age and rare in people under 50 years of age.
Other types of arthritis, including psoriatic, rheumatoid and infectious arthritis, can also affect the hip. They usually cause additional symptoms and affect multiple joints.
Groin hernia
In an inguinal hernia, the underlying tissue and organs are pushed through the weakness in the lowest part of the abdominal wall, causing a bulge in the groin area. This area may be painless or have aching pain or discomfort, especially when you bend, lift, or cough.
Some people think that women cannot get inguinal hernias, but this is not true. Due to differences in anatomy, women are less likely to develop hernias than men. However, about 3% of women may experience an inguinal hernia at some point in their lives. Increasing age is the main risk factor.
Ovarian torsion or other reproductive system problems
Because of the way the nerves interconnect in this groin, various problems with the female reproductive system sometimes cause pain in this area, usually along with additional symptoms.
In an ectopic pregnancy, the fertilized egg implants outside the uterus, usually in the fallopian tube. It can cause pain in the groin, lower abdomen or back, along with other pregnancy symptoms such as missed periods and tender breasts. If the fallopian tube ruptures, this can be a life-threatening emergency.
Ovarian torsion is another medical emergency in which the affected ovary (and sometimes the fallopian tube) twists, restricting blood flow to the ovary. It occurs in those with a growth, such as an ovarian cyst, on the affected ovary. The pain is usually sudden and severe, usually in the lower abdomen – but sometimes you can feel it in the groin.
Other causes
There are other less common causes of pain in or near the groin. Certain cancers can cause pain in the area, or a pinched nerve can cause burning and stinging pain.
Problems with hip development, such as femoroacetabular impingement, can predispose someone to pain later in life.
If you have moderate to severe groin pain from a recent injury, see your doctor. They can help you understand how to manage your recovery.
Do not ignore groin pain that develops gradually. For athletes dealing with athletic pubalgia or related conditions, experts can help you determine the cause and the best treatment option.
Seek emergency medical help if groin pain develops more quickly and is accompanied by other symptoms, such as fever, nausea, severe pain, or pain that radiates to the side or back.
Your medical history is key to diagnosing the underlying cause of your groin pain. The type of pain, exact location, onset and accompanying symptoms give important clues to your doctor.
A medical examination is also critically important. Your healthcare provider will likely check for tenderness in the area and surrounding regions. They can also check muscle strength and range of motion.
A medical history and examination are sometimes sufficient to diagnose the cause of groin pain. Additional testing may be required in certain circumstances. Examples may include:
- Basic blood tests to check for infection, inflammation and overall health, such as a complete blood count (CBC)
- Pregnancy test
- Urine tests, for example, to check for signs of a urinary tract infection (UTI)
- Imaging tests such as computed tomography (CT) scans for conditions such as kidney stones
Imaging tests can offer more specific information about chronic groin pain, such as that experienced by athletes. These may include ultrasounds, X-rays, MRIs, or other tests.
Treatment for groin pain depends on the underlying cause. For groin muscle strains, it’s important to rest the muscle while it heals. Elevate the injured area and apply ice repeatedly for the first day or two afterward. Pain relievers such as Advil (ibuprofen) or Tylenol (acetaminophen) can also help.
Physical therapy (PT) can also help with more serious strains, but only after the area has healed. PT can help strengthen muscles and improve range of motion. Visiting a physical therapist within 1-2 weeks can help symptoms improve sooner. It may still be weeks or longer before you can safely return to athletic activities, putting you at risk of muscle impingement.
Athletes with chronic groin pain benefit from similar strategies, and orthopedic sports specialists can be especially helpful in guiding treatment. Steroid injections and compression garments may also be helpful. Some people may eventually need surgery.
Other potential treatments include:
- Physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and potentially surgery for hip osteoarthritis
- Injections into the hip joint (cortisone or other drugs)
- Antibiotics for urinary tract infection
- Ovarian hernia or torsion surgery
- Shock wave treatment for kidney stones
Groin pain in women can be caused by medical conditions, including those of the musculoskeletal, reproductive, and urinary systems. Get emergency medical help for severe groin pain and pain with fever or nausea.
Physical therapy and specific exercises can often help improve strength and range of motion and reduce pain. Surgery may ultimately be the most effective option.