Groin pain occurs where the lower abdominal wall and pelvis meet the leg. In men, a muscle strain is the most common acute cause, but many other conditions cause pain here, some musculoskeletal and some not. Getting the right diagnosis is what makes treatment work. So what causes groin pain in men, and how is the cause found?
If your groin pain is specifically related to running or sport, see our dedicated page on groin pain in runners. This page covers the wider range of causes in men, including non-musculoskeletal ones.
Musculoskeletal causes of male groin pain
Muscle strain
A groin strain — a “pulled groin” — usually happens when the hip puts a muscle in an awkward, loaded position. The adductor and hip flexor muscles are most often involved, giving sharp groin pain, tightness or spasm, and leg weakness.
Hip arthritis
The hip joint sits deep at the front of the hip, and the wearing away of the cartilage can cause hip and groin pain. It usually builds gradually, worse with weight-bearing activity.
Femoroacetabular impingement (FAI)
FAI, or hip impingement, is a motion-related hip problem in which bony prominences at the edges of the ball-and-socket joint restrict movement and cause pinching. It typically causes hip or groin pain at the extremes of movement, ranging from sharp to dull.
Osteitis pubis
Osteitis pubis (pubic overload) is inflammation of the pubic symphysis, usually from change-of-direction sports. Pain occurs in the lower abdomen or adductor/groin region and is sometimes mistaken for a hernia.
Hip stress fracture
Stress fractures of the hip and pelvis — commonly the femoral neck or pubic ramus — cause sharp groin pain and limping, often with adductor pain.
Hip osteonecrosis
Hip osteonecrosis is a rare cause where the bone cells in the femoral head die after a loss of blood supply. It starts as a dull hip or groin ache and worsens until weight-bearing becomes difficult.
Hernia: a key cause of groin pain in men
Hernias are an important cause of male groin pain. A hernia is a weakness or hole in the lower abdominal wall through which abdominal contents (fat or intestine) push. There are two types: inguinal (common) and femoral (less common but more serious). A hernia typically causes sharp pain triggered by increased abdominal pressure — coughing, sneezing, or lifting — and may be accompanied by a visible bulge.
A sports hernia is not a true hernia but a weakness of the abdominal wall that’s thought to irritate the abdominal wall nerves, causing groin or inguinal pain.
Non-musculoskeletal causes of groin pain in men
This is where male groin pain differs most from sport-related groin pain — several important causes have nothing to do with muscles or joints, and need a different specialist.
Testicular pain
Problems in the testicle commonly refer to the groin. For example, epididymitis — inflammation of the duct behind the testicle — causes groin and testicular pain, often with testicular swelling and sometimes discharge. Testicular pain should always be assessed promptly, as some causes (such as testicular torsion) are emergencies.
Kidney stones
A kidney stone is a small clump of minerals in the kidney. As it passes through the urinary tract, it causes waves of lower abdominal pain radiating to the groin, sometimes with blood in the urine and more frequent urination.
Groin nerve pain
A pinched nerve from the lumbar spine, front of the hip, or groin can cause groin pain, numbness, and tingling — for example,e obturator nerve entrapment, ilioinguinal nerve entrapment, or meralgia paraesthetica.
Abdominal causes (rare)
Occasionally, abdominal conditions such as an aortic aneurysm or diverticulitis present with groin pain — rare, but important not to miss.
How is male groin pain diagnosed?
Because the causes are so varied, diagnosis starts with a careful history and a systematic examination of the hip, groin, and pelvis — including the abdomen, testicles, and nervous system. It’s essential to see a doctor experienced in assessing the many possible sites of male groin pain.
Tests then confirm the likely diagnosis. X-rays show bone and joint problems; an MRI examines soft tissues and the bladder, testicles, or pelvis; and an ultrasound assesses structures in real time and confirms a hernia or testicular problem. Sometimes a diagnostic injection helps — if the pain temporarily disappears after an anaesthetic injection, the source is almost certainly where the anaesthetic was placed. Examples of such groin injections include the hip joint, iliopsoas tendon, pubic symphysis, obturator nerve, pudendal nerve, and ilioinguinal nerve, all done under ultrasound guidance.
Frequently asked questions about groin pain in men
Is my groin pain muscular or something more serious?
Most acute male groin pain is due to muscle strain or other musculoskeletal causes (hip, osteitis pubis, hernia). But groin pain with testicular swelling or pain, blood in the urine, a lump, fever, or severe, sudden pain points to a non-musculoskeletal cause (testicular, urological, or abdominal) that needs prompt medical assessment.
When should I worry about groin pain in men? (Red flags)
See a doctor urgently for sudden severe testicular pain (possible torsion — an emergency), a tender lump, blood in the urine, fever, or pain with abdominal swelling. These suggest causes beyond a simple strain.
Can testicular problems cause groin pain?
Yes. Conditions such as epididymitis commonly cause groin and testicular pain, and testicular torsion is a surgical emergency. Any new testicular pain or swelling should be checked promptly.
Can a kidney stone cause groin pain in men?
Yes. A stone passing through the urinary tract causes waves of loin-to-groin pain, often with blood in the urine and frequent urination — a different pattern from musculoskeletal groin pain.
Can sciatica cause groin pain in men?
It can, though it’s less common. Nerve irritation from the upper lumbar spine can radiate into the hip, groin, and upper thigh.
What type of doctor should I see for groin pain?
Start with a doctor experienced in assessing the full range of groin causes — musculoskeletal and otherwise — who can then direct you to the right specialist (sports medicine, urology, or general surgery) based on the likely cause.
Final word from Sport Doctor London about lower abdominal and groin pain in men
Groin pain in men is complex, with many possible causes — and sometimes more than one at once. Some are musculoskeletal, and some aren’t, so it’s important to see a doctor experienced in assessing the different causes, who can identify the source and direct you to the right treatment.
To book a hip and groin assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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