Danielle Matias, PA-C; Demi Foster, APRN

Persistent groin pain can make walking, climbing stairs, exercising, sitting, or caring for a child difficult. Some women also describe inner-thigh pain, hip or low-back pain, vaginal discomfort, urinary symptoms, or pain after childbirth or surgery. When investigations have not provided a clear explanation, the uncertainty can become as frustrating as the pain itself.

At Caring Medical, we consider whether a musculoskeletal problem contributes to this pattern. Painful tendons, ligament attachments, hip disorders, sacroiliac problems, or irritation of nearby nerves can sometimes be overlooked. Ligament laxity—reduced restraint from supporting ligaments—is one possible contributor in selected patients, rather than an explanation for every woman with groin pain.

The starting point is identifying the cause. We explain childbirth-related symptoms, pelvic support, hip and spinal referral, nerve pain, and injection evidence so that readers can understand the different possibilities.

Where is the groin, and what can cause pain there?

The groin, also called the inguinal region, is the fold where the lower abdomen meets the upper inner thigh. The pubic region lies between the two sides. Muscles, tendons, ligaments, nerves, abdominal-wall structures, and the hip joint are closely related in this area. Pain can also be referred from the pelvis or spine.

Musculoskeletal causes include adductor tendon injury, iliopsoas problems, pubic symphysis disorders, hip arthritis, labral pathology, and some lumbar or sacroiliac conditions. Other possibilities include a hernia, kidney stones, urinary infection, gynecological disease such as endometriosis or an ovarian disorder, and gastrointestinal disease. Enlarged lymph nodes, skin infection, and other local conditions can also produce discomfort.

A previous normal investigation narrows particular possibilities; it does not automatically prove a ligament problem. Similarly, pain remaining after gynecological or hernia treatment can reflect more than one condition, postoperative nerve irritation, or a different pain source requiring assessment.

When groin pain needs urgent attention

Seek urgent assessment for sudden severe pelvic or groin pain, especially with vomiting, fainting, fever, or a possible pregnancy. Pain with vaginal bleeding during a possible pregnancy requires prompt evaluation. A painful groin bulge that will not reduce, inability to bear weight after injury, or fever with severe hip pain can also indicate an urgent problem.

New urinary retention, loss of bowel or bladder control, saddle-region numbness, or progressive leg weakness requires emergency assessment. These neurological changes differ from longstanding stress urinary leakage. Persistent unexplained weight loss, a growing mass, or worsening night pain also deserves medical attention.

A more useful way to organize musculoskeletal groin pain

The Doha agreement separates athletic groin pain into adductor-related, iliopsoas-related, inguinal-related, and pubic-related clinical entities, together with hip-related pain and other causes. The classification uses history and examination findings, and more than one category can coexist. It was developed for athletes; women with postpartum or non-athletic pelvic symptoms may need additional diagnostic considerations. (1)

Newer research specifically involving female athletes

A 2024 cross-sectional study assessed 91 elite female team-sport athletes. Thirteen reported current hip or groin problems, a preseason point prevalence of 14.3%. Iliopsoas-related findings were the most common clinical category. Some athletes had multiple categories, so category percentages should not be treated as percentages of all 91 participants. (2)

This supports keeping hip-flexor and hip-joint problems visible when evaluating female athletes. The small symptomatic subgroup and single preseason assessment do not establish the most common cause of groin pain in all women. These problems can arise through repeated loading as well as a major traumatic injury. Our discussion of sports-related groin pain addresses the athletic presentation in more detail.

Why surgical statistics cannot diagnose an individual patient

An earlier systematic review of 4,655 athletes in surgical studies reported femoroacetabular impingement in 32%, athletic pubalgia in 24%, adductor pathology in 12%, inguinal pathology in 10%, and labral pathology in 5%. These describe a selected surgical literature, rather than the distribution of causes among all women with groin pain. (3)

The study remains useful because it demonstrates both inside-joint and outside-joint causes. It does not show that most groin pain requires surgery or that tenderness at one attachment identifies a specific procedure.

Hip-joint problems, impingement, and labral tears

Hip osteoarthritis, a symptomatic labral tear, femoroacetabular impingement syndrome, and instability can produce groin pain. The labrum is the ring of cartilage around the hip socket. Femoroacetabular impingement involves contact related to the shape and motion of the femoral head–neck region and acetabulum, or hip socket.

Cam morphology concerns the femoral side; pincer morphology concerns the socket side. These shapes are not automatically painful. Impingement syndrome requires an appropriate combination of symptoms, clinical signs, and imaging; it is not simply another name for advanced bone-on-bone arthritis.

Painful catching or clicking can be relevant, but similar noises can arise from tendons. Lateral hip pain, often grouped under greater trochanteric pain syndrome or hip bursitis, also needs to be distinguished from pain originating inside the joint. A woman can have both problems.

Our articles on femoroacetabular impingement and hip labral tears provide more focused discussions. Neither a labral finding nor a particular bone shape, by itself, determines whether surgery or an injection is appropriate.

Could the sacroiliac joint or lumbar spine be referring pain to the groin?

The sacroiliac joints connect the sacrum with the pelvic bones. Pain from this region can coexist with groin, buttock, or low-back symptoms. Lumbar disc and nerve disorders can also cause pain felt beyond the back.

A retrospective study compared 127 patients with sacroiliac dysfunction, 146 with lumbar spinal stenosis, and 124 with lumbar disc herniation, excluding patients with hip disorders. Groin pain occurred in 46.5%, 6.8%, and 8.1%, respectively. Sacroiliac provocation findings and tenderness near the posterior pelvic landmarks helped distinguish the groups. (4)

These percentages apply to the selected diagnostic groups, not to everyone with unexplained groin pain. The study supports considering the sacroiliac region when hip disorders have been excluded and groin pain accompanies back or buttock pain.

Some lumbar patients had nerve-root symptoms, while others had disc-related pain without radiculopathy. This is why an MRI report of a bulging disc must be interpreted alongside the examination. Groin pain does not prove that a disc bulge is symptomatic, and the coexistence of groin pain and disc degeneration does not establish which problem developed first.

Our discussion of Prolotherapy for low back pain explains ligament support, lumbar instability, and the limits of treatment evidence.

Iliolumbar ligament pain and the problem of referral

The iliolumbar ligament connects the lower lumbar region with the iliac crest, the upper rim of the pelvis. Irritation or injury may contribute to pain near the crest and lower back, sometimes with a broader referred pattern. Bending, twisting, prolonged sitting or standing, and trauma can be relevant to the history.

An anatomical study examined 30 iliolumbar ligaments from 15 cadavers and identified sensory nerve structures, including free nerve endings. This supports biological plausibility that the ligament can contribute to pain. It does not establish that iliolumbar injury is a common cause of vaginal or rectal pain, or prove an injection treatment effective. (5)

The illustration shows the relationship between the lower spine and pelvis. In our clinical perspective, supporting tissues should be looked at when local findings and the symptom pattern agree. Tenderness is one clue, not a standalone diagnosis. Our article on iliolumbar syndrome and iliac crest pain explains this region further.

Iliopsoas injury and snapping hip

The iliopsoas helps flex the hip. Pain may be felt deep in the groin or at the front of the hip, particularly with running, kicking, rising from sitting, or repeated hip flexion. An injury can begin suddenly or develop with repeated loading.

An earlier prospective study examined 207 athletes, including only 11 women. It identified overlapping clinical patterns, including iliopsoas-related pain, rather than one cause for every patient. Its very small female subgroup limits conclusions about women generally. The newer female-athlete study also found iliopsoas-related problems important. (6) (2)

Sometimes a tendon moves over a neighboring structure and produces snapping. Painless snapping can be incidental. Painful snapping should be distinguished from a labral problem and other hip conditions. It should not automatically be attributed to ligament laxity or forward displacement of the hip.

Our original clinical example described an athlete with iliopsoas tenderness and lumbar degeneration whose familiar pain was also reproduced around pelvic supporting tissues. The useful lesson is to examine neighboring structures rather than assigning all symptoms to the first tender muscle or MRI finding. That observation does not validate a “jump sign” as a definitive test. See our article on snapping hip syndrome.

Pubic symphysis pain, adductor attachments, and osteitis pubis

The pubic symphysis is the joint joining the pubic bones at the front of the pelvis. A fibrocartilaginous disc and surrounding ligaments help support it. The adductor tendons and abdominal attachments also transmit forces through the region.

Pain may occur with running, kicking, cutting, squatting, sit-ups, stair climbing, or turning in bed. Some women describe tenderness over the joint, inner-thigh radiation, pain with coughing or sneezing, or an altered gait. These symptoms do not distinguish joint irritation, tendon injury, substantial separation, and infection without assessment.

At Caring Medical, we consider whether a painful attachment is being loaded against a poorly supported pelvic region in selected cases. However, not every painful adductor reflects an unstable pubic symphysis. Tendon capacity, strength, coordination, and training load can matter independently, and strengthening is not automatically futile.

What does osteitis pubis mean?

Osteitis pubis describes a painful condition affecting the pubic symphysis and adjacent bone, often associated with repetitive loading and a bony stress response. It can cause anterior or inner-groin pain and discomfort near the lower abdominal or adductor attachments. A foundational review described a broad differential diagnosis and variable treatment evidence. (7)

Imaging may show edema, sclerosis, or other changes, but findings need clinical context. Osteitis pubis is different from osteomyelitis, an infection of bone. A stress fracture or infection must not be treated as routine tendon or ligament pain.

Inflammation does not mean that every effort to relieve pain is harmful. Ice, anti-inflammatory medication, and physical therapy should not be grouped together as treatments that inevitably accelerate degeneration. Short-term symptom relief and progressive rehabilitation can have appropriate roles; effects depend on the treatment, dose, duration, and diagnosis.

Nerve irritation: Burning, electric, genital, or postoperative pain

The ilioinguinal, iliohypogastric, and genitofemoral nerves can contribute to pain in the lower abdominal, inguinal, or upper-thigh region. Pudendal nerve problems more often involve perineal or genital symptoms. Cluneal nerves primarily supply buttock regions. Their territories should not be combined into one undifferentiated “groin nerve” map.

A 2025 review described nerve-related athletic groin pain and the difficulty created by anatomical variation and sensory overlap. Burning, electric sensations, numbness, or marked sensitivity may suggest a neuropathic component, but pain quality alone is insufficient. The review discusses examination, selected imaging, rehabilitation, nerve blocks, and surgery for appropriate refractory cases. (8)

Pain persisting after hernia repair can involve nerve injury, recurrence, scar-related problems, or a separate musculoskeletal source. It does not necessarily mean the original hernia diagnosis was wrong. Likewise, vaginal pain needs its own consideration of pelvic-floor, gynecological, dermatological, and nerve causes.

Pregnancy, childbirth, and persistent pelvic girdle pain

Pregnancy changes loading, posture, and pelvic support. Some women develop pain around the pubic symphysis, sacroiliac joints, lower back, or groin. Postpartum pain can involve joints, muscles, tendons, the pelvic floor, nerve injury, or other conditions; hormonal ligament changes are not a complete explanation.

Difficulty walking, turning in bed, climbing stairs, or standing on one leg can be important clues. Severe new pubic pain after delivery may require assessment for significant symphyseal separation or another injury. Symptoms should not simply be dismissed as an unavoidable consequence of childbirth.

A 2026 systematic review and meta-analysis of 15 studies found that core-stabilizing exercise improved postpartum lumbopelvic pain and disability. Certainty was moderate for pain, high for disability, and low for quality of life. The review did not test Prolotherapy or establish one exercise program suitable for every postpartum diagnosis. (9)

Anna’s story: Preserving the patient experience

Anna Hamman, an Air Force veteran and competitive swimmer, described persistent groin, inner-thigh, hip, pelvic-floor, and low-back pain after a difficult delivery. Her account explains the strain of caring for a young child while seeking a diagnosis and struggling to resume activity.

She reported initial spinal findings, subsequent investigation of pubic-joint motion and osteitis pubis, and discussion of pelvic fusion. She pursued nonsurgical treatments, including Prolotherapy, and later described an overall 85%–90% pain reduction after seven Caring Medical visits. She also received other interventions and still had limitations with walking and running. Her story illustrates a meaningful individual improvement, not a controlled demonstration that injections caused every change or a response rate another patient can expect. (10)

The clinical lesson is to consider pelvic and spinal contributors without assuming incidental MRI findings explain everything. Her reported imaging changes do not establish that Prolotherapy regenerates discs.

For a focused discussion, see pelvic girdle and pubic symphysis symptoms following childbirth and menopause.

Urinary symptoms, pelvic-organ prolapse, and pain after sling surgery

Groin pain and urinary symptoms can coexist without one causing the other. Stress urinary incontinence, urgency, bladder pain, and difficulty emptying are different problems. Pelvic-floor dysfunction may involve excessive muscle tension, impaired coordination, weakness, or a combination. It is not synonymous with loose ligaments.

Pelvic-organ prolapse involves reduced support of the vagina or pelvic organs. The uterosacral and cardinal support complexes are anatomically different from the ligaments around the pubic symphysis. Prolapse may produce pressure, a bulge, or bladder and bowel complaints, but these symptoms do not establish a musculoskeletal injection target.

New or persistent pain after mesh or sling procedures

An older retrospective study examined 92,246 first-time surgical mesh procedures for stress urinary incontinence. It documented complications and later interventions, showing why persistent symptoms deserve attention. Its overall complication figures should not be presented as the frequency of chronic groin pain alone. (11)

The updated 2023 review of single-incision slings included 62 studies and 8,051 women. Outcomes differed by the comparison procedure. Evidence about pain, mesh complications, and further surgery was not equally certain across comparisons. Different sling routes and procedures should not be treated as interchangeable. (12)

Pain after a sling may warrant assessment for mesh exposure, infection, obstruction, nerve irritation, muscle pain, or another diagnosis. Prolotherapy has not been established as a treatment for eroded mesh, a mechanically obstructing sling, urinary incontinence, or pelvic-organ prolapse. Our article on pelvic-floor disorders and pelvic girdle pain provides related context.

How the pain source is evaluated

The timing, location, and provoking activities help guide evaluation. Relevant details can include childbirth, training changes, trauma, prior pelvic or hernia surgery, menstrual association, urinary or bowel symptoms, and painful versus painless snapping.

Depending on the presentation, examination can assess gait, hip movement, resisted muscle loading, the abdominal wall, pubic and sacroiliac regions, neurological findings, and pelvic-floor function. Reproducing familiar pain can help localization, but tenderness does not demonstrate damaged ligaments or justify injection by itself.

Ultrasound, X-rays, MRI, laboratory testing, or gynecological and urinary investigations may answer different questions. Hip imaging is useful for certain joint or bone problems; ultrasound may assess selected tendon or hernia concerns; MRI can help investigate stress injury or complex pelvic symptoms. Not every patient needs every test.

Our reader examples describe women whose gynecological investigations did not fully explain persistent groin pain, altered walking, buttock symptoms, or snapping. These experiences support reassessing the differential diagnosis. They do not mean that a reassuring pelvic scan excludes all gynecological disease or proves an unstable pelvis.

Treatment begins with the diagnosis

Treatment may involve adjusting aggravating activity, progressive exercise, medication when appropriate, pelvic-floor therapy for a diagnosed pelvic-floor problem, or management of a hip, nerve, hernia, urinary, or gynecological condition. Bone stress injuries and serious pathology require their own management rather than exercise through pain.

For longstanding adductor-related groin pain, a randomized study of 68 athletes found that active training emphasizing strength and coordination produced more pain-free returns to sport than physiotherapy without active training. The findings apply to that clinical population and do not resolve every cause of female groin pain. (13)

Relative rest is different from indefinite inactivity. Stretching alone may not address tendon capacity or pelvic control, and aggressive stretching can provoke some conditions. Conversely, unsuccessful stretching does not prove ligament laxity. Rehabilitation should reflect the diagnosed problem rather than a universal instruction to strengthen or stretch everything.

Surgery can be appropriate for selected hernias, hip conditions, significant structural injuries, or complications. Its role cannot be decided from a label such as “pubalgia,” which describes pubic-region pain without necessarily identifying one tissue source.

Prolotherapy for groin and pelvic pain: What does the research show?

Dextrose Prolotherapy uses injections intended to provoke a local biological response in selected musculoskeletal tissues. Proposed mechanisms include effects on pain signaling and connective-tissue repair. PRP is a different preparation made from blood, and evidence for one should not be substituted for the other.

A relevant 2026 review

A 2026 narrative review examined Prolotherapy for chronic musculoskeletal pelvic pain, including sacroiliac pain, coccydynia, deep gluteal syndrome, and chronic groin pain. It describes possible benefits while emphasizing the need for prospective clinical studies. A narrative review does not provide a new randomized comparison or establish effectiveness for every pelvic diagnosis. (14)

The review is a useful update to this article because it places groin pain within the wider musculoskeletal pelvis. It does not establish treatment of ovarian disease, infection, a true hernia, mesh complications, or unexplained vaginal pain.

The foundational groin-pain case series

A consecutive series treated 24 elite male athletes—22 rugby players and two soccer players—with longstanding groin pain associated with osteitis pubis or adductor tendinopathy. The study used dextrose and lidocaine injections at selected painful adductor, abdominal, or pubic sites. Average sports pain decreased from 6.3 to 1.0; 20 patients reported no pain and 22 had unrestricted sports participation at final follow-up. (15)

These are encouraging observations, but the study had no randomized comparator and involved selected male athletes. It cannot establish the treatment’s effectiveness in postpartum women, identify which component caused improvement, demonstrate ligament strengthening, or promise permanent pain relief. Its injection sites and schedule describe a research protocol, not a universal treatment map.

What a systematic review concluded

A 2021 systematic review included 19 studies of conservative treatment for longstanding adductor-related groin pain. It identified Prolotherapy among potentially useful approaches but concluded that the literature was limited and generally of low quality. Exercise-related approaches also remained important. Favorable case-series results need stronger controlled confirmation. (16)

PRP: A newer case report, not proof of superiority

A 2024 report described a 17-year-old male soccer player treated with an ultrasound-guided PRP injection and a structured physical-therapy program. He returned to sport at six weeks and reported reaching approximately 95% of his previous level at three months. Because this was one patient receiving combined treatment, it cannot isolate PRP’s contribution, establish a response rate in women, or show that PRP outperforms rehabilitation or dextrose. (17)

Our clinical perspective—and the limits of treatment claims

At Caring Medical, our interest includes painful ligament and tendon attachments, pubic and sacroiliac support, and referral from neighboring structures. The fibro-osseous junction is the region where a tendon or ligament attaches to bone. Such attachments can be pain generators, but they are not the source of every case of groin pain.

Our clinical discussion concerns injections directed toward selected painful supporting tissues. That clinical approach must be distinguished from proof that the pelvis has been structurally repaired. Improvement in pain, gait, or activity is meaningful; it does not directly measure ligament strength or demonstrate a permanent cure.

Injection risks include soreness, bleeding, infection, and injury to nearby nerves or other structures. Pelvic and groin anatomy makes accurate diagnosis and technique important. Small studies cannot rule out uncommon complications. Persistent pain after one treatment is a reason to reconsider the explanation, not assume that a larger area necessarily requires injections.

What this means for women seeking answers

Groin pain may arise from the hip, pubic region, tendons, pelvic floor, spine, nerves, or internal organs. Several contributors can coexist. Childbirth and surgery are important context, but neither proves a single diagnosis.

Newer research improves our understanding of female-athlete patterns and postpartum rehabilitation, while the 2026 Prolotherapy review supports further investigation of musculoskeletal pelvic treatment. Controlled evidence remains limited for groin-specific injections, particularly in women.

The useful next question is which findings explain the familiar pain and which treatments have evidence for that particular problem. A careful distinction between diagnosis, clinical hypothesis, and treatment outcome helps preserve options without promising a result the research cannot guarantee.

Medical disclaimer: This article provides general patient education and does not diagnose groin or pelvic pain or recommend a particular procedure. New, severe, postoperative, pregnancy-related, or progressive symptoms require an appropriate medical evaluation.

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