Groin Pain (Inguinodynia)

What is inguinodynia?

Inguinodynia means pain in the groin. It is a description, not a diagnosis. The groin is a crowded area: muscles of the belly and the inner thigh attach to the pubic bone, the hip joint sits just below, and several nerves pass through on their way to the skin. Pain from any of these can feel the same to you. Surgeons also use the word for groin pain that lasts after hernia surgery.

Does groin pain always mean a hernia?

No. A hernia is one cause among many. In a large clinic that sees athletes with groin pain, the most common source was the adductor muscles on the inside of the thigh, and 44 percent of patients had more than one cause at the same time.¹,²

Common causes of groin pain

• Strained muscles or tendons, most often the inner thigh (adductors) or the hip flexor
• The hip joint, such as arthritis or a tear in the cartilage rim
• The pubic bone, where the belly and thigh muscles attach
• An irritated nerve in the groin
• The lower back: the nerves that supply the groin start in the spine, so a pinched nerve there can be felt as groin pain
• In women, the ovaries, endometriosis, or round ligament pain during pregnancy
• A hernia

What points to a hernia?

A bulge you can see or feel, often larger at the end of the day or when you cough, that shrinks or disappears when you lie down. Hernia pain is usually a heavy, dragging ache at the bulge. In most people an exam is all it takes to confirm a hernia; imaging is only needed now and then.³ Not sure? Try the 2-minute hernia self-check.

Can overuse cause groin pain?

Yes. It is one of the most common reasons people see me for groin pain. The pain starts within a day or two of doing something new or doing more of it. The spot is tender to press, it hurts when you use that muscle, and there is no bulge. It usually goes away within a few weeks once you back off.

Common triggers

• A harder workout than usual
• A new exercise or a new class
• More weight on the bar
• A new job with more lifting, bending, or standing
• A weekend of yard work, moving, or a home project

What helps

Rest from the activity that started it, put ice on the sore spot, and take an anti-inflammatory pain reliever such as ibuprofen or naproxen if it is safe for you.⁴ Talk with your primary care doctor too. If the pain is not improving after a few weeks, or you find a bulge, come see me.

When the pain does not go away

Sometimes the pain comes from a problem in the muscles or the hip that needs its own treatment. Two of the most common are a sports hernia and a labral tear.

• Sports hernia (also called a sportsman's hernia). Despite the name, this is not a true hernia. It is a strain or tear of the muscles or tendons in the lower belly or groin, most often where they attach to the pubic bone. There is no bulge.⁴
• Labral tear. The labrum is a ring of tough cartilage around the rim of the hip socket. It works like a gasket: it seals the joint and helps hold the ball at the top of the thigh bone in the socket. A labral tear is a rip in that ring.⁵

If I cannot find a hernia on exam or on standard imaging, I order an MRI to look for other causes. An MRI can show a labral tear. I do not repair a sports hernia or a labral tear. If you have a labral tear, I send you to an orthopedic surgeon. If you have a sports hernia, I help you find a specialist in the area who treats it.

What if I have a hernia and groin pain at the same time?

Sometimes a patient has had a small hernia for months or years that never bothered them, then starts a new workout or a big yard project and develops groin pain. The hernia and the pain are both there, but they have nothing to do with each other. The pain is coming from a strained muscle or tendon nearby, not from the hernia.

Why fixing the hernia may not fix the pain

Hernia surgery repairs the weak spot in the wall. It does not heal a strained muscle, a sore hip, or an irritated nerve. If the pain was never coming from the hernia, it will still be there after surgery, with a fresh incision on top of it. Studies of hernia surgery have found that people with more groin pain before surgery are more likely to have pain that lasts after it.³,⁶,⁷

What I do in this situation

I will repair a hernia in someone who also has groin pain. Before we schedule surgery, we talk at length about where your pain may be coming from, and about the real chance that the pain will still be there after the hernia is fixed. If you would rather wait and see whether the pain goes away first, a hernia that causes few symptoms can usually wait safely: in a large trial of men with hernias that caused few symptoms, the hernia became stuck in about 1.8 of every 1,000 patients per year.⁸

When should I go to the ER?

What about pain that lasts after hernia surgery?

Some soreness after surgery is normal and fades over a few weeks. Pain that still interferes with daily life 3 months after surgery is called chronic postoperative inguinal pain. It affects about 10 to 12 percent of patients and usually improves over time. Severe pain that stops work or daily activity is less common, 0.5 to 6 percent.³

Younger age, being female, more pain before surgery, a repair of a hernia that came back, and an open repair all raise the risk. A robotic or laparoscopic repair lowers it.³

If the pain after surgery is the same pain you had before surgery, it may well be coming from somewhere else, especially if that pain never went away before the operation. Pain that lasts after surgery can be treated. Options include medicines, nerve blocks, and for some patients an operation to cut the irritated nerve (neurectomy).³ Tell me if your pain is not improving.

References

1. Taylor R, Vuckovic Z, Mosler A, et al. Multidisciplinary assessment of 100 athletes with groin pain using the Doha agreement: high prevalence of adductor-related groin pain in conjunction with multiple causes. Clin J Sport Med. 2018;28(4):364-369. https://doi.org/10.1097/JSM.0000000000000469

2. Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768-774. https://doi.org/10.1136/bjsports-2015-094869

3. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165. https://doi.org/10.1007/s10029-017-1668-x

4. American Academy of Orthopaedic Surgeons. Sports Hernia (Athletic Pubalgia). OrthoInfo. Accessed September 26, 2026. https://www.orthoinfo.org/diseases--conditions/sports-hernia-athletic-pubalgia

5. American Academy of Orthopaedic Surgeons. Femoroacetabular Impingement. OrthoInfo. Accessed September 26, 2026. https://www.orthoinfo.org/diseases--conditions/femoroacetabular-impingement

6. Reinpold WM, Nehls J, Eggert A. Nerve management and chronic pain after open inguinal hernia repair: a prospective two phase study. Ann Surg. 2011;254(1):163-168. https://doi.org/10.1097/SLA.0b013e31821d4a2d

7. Pierides GA, Paajanen HE, Vironen JH. Factors predicting chronic pain after open mesh based inguinal hernia repair: a prospective cohort study. Int J Surg. 2016;29:165-170. https://doi.org/10.1016/j.ijsu.2016.03.061

8. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA. 2006;295(3):285-292. https://doi.org/10.1001/jama.295.3.285