Common in sport, and men see a doctor lessStrong evidence
Half (49%) of 695 Danish sub-elite male footballers reported hip or groin pain during a season, 31% of them for more than 6 weeks, and in the same sport men had about 2.4 times women's rate of groin injury (in pooled studies, many at high risk of bias). Outside sport, we found no count of groin pain in men in general; the figures are for its causes, and kidney stones, for one, are commoner in men (10.6% of US men had had one, against 7.1% of women).
Men also see a doctor less: across 446 UK general practices, men's consultation rate was 32% lower than women's, most of all between 16 and 60, though it was similar when illness was comparable. In a UK study of 45 men with testicular cancer, some delayed because they didn't recognise the signs, were embarrassed or didn't want to seem weak.
Sources 1, 2, 3, 4, 5
In sport: the inner thigh, the lower tummy wall, the pubic bone, the hip and the boneStrong evidence
The Doha agreement, an international consensus, sorts athletes' groin pain into four patterns by the history and examination: adductor-related (the inner thigh near the pubic bone), iliopsoas-related (the front of the hip), inguinal-related (just above the groin crease, with no hernia to feel) and pubic-related (right on the pubic bone). In 207 athletes at one groin clinic, 196 of them men, adductor-related pain was the main problem in 58% and iliopsoas-related pain in about a third, and a third had more than one source. Groin injuries were commoner on the dominant (kicking) leg in 998 sub-elite male footballers, but otherwise the side rarely names the cause.
Doha adds that the hip joint "should always be considered": it was the commonest single source (56%) in 894 sports clinic patients, 73% of them men, and it was felt in the groin by 55% of 51 people whose hip pain was confirmed by an injection. A cam shape (a bony bump where the ball of the thighbone meets its neck, linked with impingement) showed on scans in 24.7% of men without symptoms against 5.4% of women, so a scan finding has to fit the examination. From about 45, hip pain that is worse walking, with stiffness after moving, is often osteoarthritis, the NHS says.
Two bone problems are uncommon but matter. A stress fracture of the neck of the thighbone (about 3 in 100 stress fractures in sport) causes groin pain that builds with exercise until it hurts at rest and at night; about half never show on X-rays, and a delay makes it more likely the bone shifts, so magnetic resonance imaging (MRI) comes next. Avascular necrosis, a loss of blood supply to the top of the thighbone, affects women as well as men, mostly young to middle-aged adults, is linked with heavy drinking, steroid treatment and sickle cell disease, among other things, and may not show on an X-ray early on.
Sources 6, 7, 8, 9, 10, 11, 12, 13, 14
Hernias: common in men, and femoral hernias aren't only women'sStrong evidence
An inguinal hernia is a bulge where the leg meets the tummy that may get bigger when you cough or strain and smaller when you lie down. In Oxford data from 1976 to 1986, an estimated 27% of men and 3% of women had one repaired in their lifetime, and in Denmark 88.6% of 46,717 groin hernia repairs were in males, peaking in boys under 5 and men aged 75 to 80. A femoral hernia is a small, grape-sized lump at the top of the thigh in the groin crease. The NHS says these mainly happen in women over 50 but "can happen to anyone": men had 37% of 3,980 femoral hernia repairs in a Swedish register from 1992 to 2006, and 28% of the men's were emergencies.
A hernia that usually goes back but suddenly won't, with more pain, a fever, being sick or no poo or wind, needs urgent help, the British Hernia Society and the international guideline's advice for patients say; in NHS terms that is 999 for a femoral hernia or if you can't poo or fart at all, and NHS 111 for any other painful hernia. Whether heavy lifting causes hernias isn't settled: the British Hernia Society lists frequent heavy lifting among the risk factors, but a review of 23 studies found too little evidence that physical work causes them, and the international guideline says heavy lifting "may predispose" to one.
After a repair, an irritated nerve can cause burning, tingling or numbness from the lower tummy to the inner thigh or scrotum, and the NHS lists groin pain or numbness lasting longer than 3 months among the possible complications.
Sources 15, 16, 17, 18, 19, 20, 21, 22, 23, 24
The testicles: an uncommon emergency, and mostly benign lumpsStrong evidence
A twisted testicle (testicular torsion) causes sudden, severe testicle pain, often with feeling or being sick, and the pain can spread to the groin or lower tummy; some men have had similar pain that settled on its own before. It is uncommon, and commonest in babies and teenagers: in US and Korean national data, torsion affects about 4 to 7 in 100,000 boys under 18 or 19 a year, and about 1.3 in 100,000 men over 18 in US data; there is no UK figure. In case series, mostly of children, about 97 in 100 testicles were saved within 6 hours, against about 43 in 100 at 19 to 24 hours; in Korean data, men over 50 lost the testicle more often.
Epididymitis, a swollen, painful tube behind the testicle, comes on suddenly or gradually with a tender, warm, swollen scrotum; it is usually a sexually transmitted infection under 35 and a urine infection over 35, and it is treated with antibiotics. Most lumps and swellings are benign, such as a cyst, fluid (a hydrocele) or swollen veins (a varicocele, found in about 15 in 100 men, mostly on the left, sometimes with a dull ache or heaviness); a review advises a check of the tummy for a varicocele on the right on its own. Long-term pain after a vasectomy is uncommon and usually treated with anti-inflammatory or nerve-pain medicines, the NHS says.
Testicular cancer is uncommon (about 2,320 UK cases a year, a lifetime risk under 1 in 100, and 96.5% surviving 10 years or more) and usually shows as a lump or swelling. The NHS says pain by itself is not usually a sign of it, but "the first symptom for some men is a sharp pain", Cancer Research UK says, so any lump, swelling or change needs checking.
Sources 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36
The prostate, the kidneys and the bladderStrong evidence
Prostatitis, an inflamed prostate, causes pain in the penis, scrotum, testicles or bottom, pain when peeing or ejaculating, and needing to pee more often; symptoms affect about 8 in 100 men in population surveys, and about a third are better within a year. About 9 in 10 men with it have the long-lasting kind, chronic pelvic pain syndrome, felt between the scrotum and the back passage, low in the tummy, at the tip of the penis or in the inner thighs, sometimes with erection problems. The American Urological Association (AUA) guideline says it "is not due to an ongoing infection" and can be worse with long sitting or after ejaculating. Sudden bacterial prostatitis comes on quickly with a high temperature and pain in the groin and lower back, and Prostate Cancer UK says to get medical advice straight away; about 1 in 10 men with it suddenly can't pee.
Prostate cancer often has no symptoms at first. The NHS lists changes in peeing, erection problems, and blood in the pee or semen, with lower back pain and weight loss as possible signs of advanced cancer; Prostate Cancer UK adds back, hip or pelvic pain, and says these symptoms are "usually caused by other things". Kidney stone pain usually starts in the side or lower back, can spread to the groin or a testicle, and comes and goes. Urine infections are less common in men, so the NHS asks any man who thinks he has one to ask for an urgent GP appointment or get help from NHS 111, as it does for blood in the pee.
Sources 37, 38, 39, 40, 41, 42, 43, 44, 31, 45, 46
When a scan or test helpsStrong evidence
For the muscles and tendons, the examination decides, and "abnormal" scan findings are common in athletes without pain; in sudden adductor injuries, the MRI grade didn't change the return time unless the tendon was completely torn. A family-medicine review suggests a pelvic MRI when adductor or pubic pain is unclear or not improving, and an ultrasound while you strain to rule out a true hernia when the pain is just above the crease. An examination confirms most inguinal hernias.
A suspected twisted testicle goes straight to an operation to check, because an ultrasound "is not reliable enough to make a diagnosis of testicular torsion in all settings", the UK guideline on epididymitis says. For a lump or lasting testicle symptoms, the doctor may shine a torch through the scrotum, and the National Institute for Health and Care Excellence (NICE) suggests an urgent ultrasound. NICE offers a low-dose computed tomography (CT) scan within 24 hours for suspected kidney stone pain, and suggests a prostate-specific antigen (PSA) blood test for pee symptoms, erection problems or visible blood in the pee; groin pain isn't on that list.
Sources 6, 47, 48, 21, 26, 32, 49, 50
How it usually goesEmerging evidence
Most men with a sudden adductor strain were back in full team training in a median of 18 days on a criteria-based plan, though complete tears took a median of 78. Long-standing adductor pain took a median of 18.5 weeks to a pain-free return in the trial. Pain just above the crease often settles with 4 to 6 weeks of physiotherapy, the American Academy of Orthopaedic Surgeons (AAOS) says, and pubic-related pain took about 10.5 weeks on average with rehabilitation in a review of mostly weak studies.
Most men watching an inguinal hernia go on to a repair within about 5 to 10 years; recovery from a repair usually takes up to 4 to 6 weeks, and 10% to 12% have lasting pain that eases over time. Epididymitis feels better within days of antibiotics but can take up to 3 months to settle fully, prostatitis symptoms clear within a year in about a third of men, and most kidney stones pass at home within a few weeks. After surgery for a twisted testicle, a Cambridge leaflet tells teenagers that nothing they did caused it, and that if a testicle is removed, the difference in fertility is only minimal. No one can promise a timescale.
Sources 47, 51, 52, 53, 21, 54, 55, 24, 31, 38, 44, 56
