Groin pain is common in athletes, but it isn’t always a muscle strain or hip injury. One important, often overlooked cause is genitofemoral nerve pain. When the genitofemoral nerve is irritated or compressed, it produces 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?

Genitofemoral nerve pain is one of several causes of groin nerve pain.

What is the genitofemoral nerve?

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

  • Genital branch — sensation to the scrotum or labia, and motor supply to the cremaster muscle in men
  • Femoral branch — sensation to the skin of the upper thigh

When the nerve is compressed or inflamed, athletes develop genitofemoral neuralgia, a form of nerve-related groin pain. The commonest cause is surgery — hernia repair or appendicectomy. Blunt trauma can also damage it, and, rarely, endurance cycling can irritate the nerve within 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 (men) or labia (women)
  • Numbness, tingling, or hypersensitivity in the front of the thigh, vulva, or scrotum
  • Pain worsens with hip extension, twisting, sprinting, or tight clothing.
  • Discomfort persists despite rest or muscle-strain treatment.t
  • Relief with sitting or lying flat

This often mimics hernia pain, making it easy to misdiagnose. Other conditions to consider include a hernia, a sports hernia, hip joint pathology, ilioinguinal nerve entrapment, and other groin nerve injuries.

Clinical assessment

On examination, a sports doctor may find:

  • Local tenderness along the nerve’s course
  • Pain reproduced on palpation over the inguinal canal or upper thigh, with a positive Tinel’s sign.
  • Preserved hip range and strength, helping rule out hip pathology
  • Sensory changes over the femoral branch — the top and middle of the front of the thigh

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

Investigations

Investigations support the diagnosis and exclude other groin causes:

  • Ultrasound to exclude a hernia or show scar tissue compressing the nerve
  • MRI pelvis/abdomen to rule out hip joint or pelvic pathology
  • Nerve conduction studies — difficult in this region, but helpful in selected cases
  • Diagnostic genitofemoral nerve block — ultrasound-guided local anaesthetic around the nerve gives temporary relief and confirms the diagnosis

How do we treat genitofemoral nerve pain?

Management usually combines conservative and interventional care:

  • Activity modification — avoid aggravating activities such as sprinting and twisting
  • Physiotherapy — core strengthening, pelvic stability, and postural correction
  • Medication — neuromodulators such as amitriptyline or duloxetine; topical lidocaine patches or capsaicin cream for skin hypersensitivity
  • Genitofemoral nerve block — an ultrasound-guided injection of local anaesthetic and cortisone relieves pain and confirms the diagnosis. We target the genital branch in the spermatic cord, which often also contains the ilioinguinal nerve. We sometimes use a nerve hydrodissection technique, which Dr Masci teaches across the UK and Europe. If the block works, radiofrequency ablation can give a more sustained effect.
  • Surgery — rarely needed, but decompression or neurectomy is an option in severe, refractory cases

Frequently asked questions about genitofemoral nerve pain

What does genitofemoral nerve pain feel like?

Burning, stabbing, or aching pain in the groin, lower abdomen, or upper thigh, often radiating into the scrotum or labia, with numbness or hypersensitivity. It typically worsens with hip extension, twisting, or tight clothing and eases when lying flat.

How is genitofemoral nerve pain different from a hernia?

A hernia usually causes a bulge and mechanical pain; genitofemoral neuralgia has no bulge and presents with neuropathic features—burning, tingling, hypersensitivity. Ultrasound excludes a hernia, and a diagnostic nerve block confirms the nerve as the source.

Why did genitofemoral nerve pain start after my hernia surgery?

Surgery is the commonest cause. The nerve runs close to the surgical field in hernia repair (and appendicectomy), so it can be irritated, stretched, or caught in scar tissue. This post-surgical pattern is well recognised.

What’s the difference between the genitofemoral and ilioinguinal nerves?

They sit close together and cause overlapping groin pain, and the genital branch of the genitofemoral nerve shares the spermatic cord with the ilioinguinal nerve. A targeted diagnostic block helps tell which nerve is responsible, since the treatment is similar but the injection site differs.

Can genitofemoral nerve pain be cured without surgery?

Usually, most athletes improve with activity modification, physiotherapy, and an ultrasound-guided nerve block, sometimes followed by radiofrequency ablation. Surgery is reserved for the few who don’t respond.

Final word from Sport Doctor London about 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’s often overlooked. Careful assessment, supported by imaging and a diagnostic genitofemoral nerve block, is key to an accurate diagnosis. With the right plan, most athletes recover well and return to sport.

To book a one-stop assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.

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