Groin pain is common in athletes, but it is not always caused by muscle strain or hip injury. One crucial but often overlooked cause is genitofemoral nerve pain. This condition occurs when the genitofemoral nerve is irritated or compressed, resulting in burning groin discomfort, altered sensation, and reduced performance. So, how do you know you have genitofemoral neuralgia, and how do we treat it, including a genitofemoral nerve block? 

What Is the Genitofemoral Nerve?

The genitofemoral nerve comes from the lumbar spine (L1–L2 nerve roots). It divides into two branches:

  • Genital branch – provides sensation to the scrotum or labia and motor supply to the cremaster muscle in men.

  • Femoral branch – supplies sensation to the skin of the upper thigh.

When this nerve is compressed or inflamed, athletes can develop genitofemoral neuralgia, a form of nerve-related groin pain.

The most common cause of genitofemoral nerve pain is after surgery for hernia repair and appendicitis. Sometimes, blunt trauma can damage the nerve. Rarely, excessive or endurance cycling can irritate the nerve in the psoas muscle. 

anatomy of genitofemoral nerve

Symptoms of Genitofemoral Neuralgia

Typical symptoms include:

  • Burning, stabbing, or aching pain in the groin, lower abdomen, or upper thigh

  • Pain radiating into the scrotum (in men) or labia (in women)

  • Numbness, tingling, or hypersensitivity in the anterior thigh, vulva or scrotum 

  • Pain that worsens with hip extension, twisting, sprinting, or tight clothing

  • Discomfort that persists despite rest or treatment for muscle strains

  • Symptoms improved with sitting or lying flat

This pain often mimics hernia-related discomfort, making it easy to misdiagnose. Other conditions need to be considered, including hernia, sports hernia, hip joint pathology, ilioinguinal nerve entrapment and other groin nerve injuries. 

Clinical Assessment

During assessment, a sports doctor may find:

  • Local tenderness along the course of the genitofemoral nerve

  • Pain is reproduced with palpation over the inguinal canal or upper thigh. Tinel’s sign over the inguinal canal can be positive. 

  • Preservation of the hip joint range of motion and strength, which helps rule out hip pathology

  • Sensory changes in the skin supplied by the femoral branch at the top and middle of the front of the thigh 

The key is identifying neuropathic-type pain rather than purely mechanical muscle pain.

Investigations

Investigations help support the diagnosis and rule out other causes of groin pain:

  • Ultrasound: Useful to exclude a hernia or visualise scar tissue that may compress the nerve.

  • MRI pelvis/abdomen: To rule out hip joint or pelvic pathology.

  • Nerve conduction studies: Difficult to perform in this region, but may help in selected cases.

  • Diagnostic genitofemoral nerve block: Injection of local anaesthetic around the nerve can temporarily relieve pain, confirming genitofemoral neuralgia. Injections are generally done with ultrasound guidance. 

Treatment Options for Genitofemoral Nerve Pain 

Management of genitofemoral nerve pain often combines conservative and interventional treatments:

  • Activity modification: Avoiding activities that aggravate symptoms, such as sprinting or twisting.

  • Physiotherapy: Core strengthening, pelvic stability, and postural correction.

  • Medication: Neuropathic pain medication (Amitriptyline or Duloxetine)  can help in persistent cases. Sometimes, we use topical treatments such as lidocaine patches or capsaicin cream to reduce skin hypersensitivity. 

  • Genitofemoral nerve block: An ultrasound-guided injection of local anaesthetic and corticosteroid can provide significant relief and confirm the diagnosis. Generally, these injections target the genital branch of the genitofemoral nerve in the spermatic cord using ultrasound guidance. Often, the ilioinguinal nerve is also contained within the spermatic cord.  If the block is successful, we often consider radiofrequency ablation for a more sustained effect. 

  • Surgery: Rarely required, but decompression or neurectomy may be considered in severe, refractory cases.

Final Word by Sportdoctorlondon on Genitofemoral Nerve Pain 

Genitofemoral neuralgia is an under-recognised cause of groin and thigh pain in athletes. Because it mimics hernia and muscle injuries, it is often overlooked. Careful clinical assessment, supported by imaging and diagnostic genitofemoral nerve block, is key to accurate diagnosis. With the right treatment plan, most athletes recover well and return to sport without long-term problems.

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