Groin pain in men has a wide range of causes, from muscle strains and hernias to hip joint problems and nerve issues. The location, onset, and quality of the pain all point toward different sources. Understanding the most likely causes can help you recognize what you’re dealing with and how urgently it needs attention.
Inguinal Hernia
Inguinal hernias are one of the most common causes of groin pain in men, and they’re far more likely in males. Roughly 27% of men will develop one at some point in their lives, compared to just 3% of women. Men are 8 to 10 times more likely to get one overall.
A hernia happens when tissue from inside the abdomen pushes through a weak spot in the lower abdominal wall. There are two types. An indirect hernia stems from an opening in the abdominal wall that was supposed to close before birth but didn’t. It can show up at any age. A direct hernia develops later in life as the abdominal wall gradually weakens, and it occurs almost exclusively in men.
The classic signs are a visible bulge in the groin or scrotum, along with discomfort, heaviness, or a burning sensation in the area. These symptoms typically get worse when you strain, lift, cough, or stand for a long time, and they improve when you lie down. Not all hernias cause pain right away. Some start as a painless bulge that only becomes uncomfortable over time.
Groin Muscle Strain
A groin strain is a tear in the adductor muscles, the group of muscles along the inner thigh that pull your leg inward. It typically feels like a sharp, twinging pain at the moment of injury, often during a sudden change of direction, a kick, or a sprint. If the muscle goes into spasm afterward, you may feel sharp stabs of pain each time it twitches. Swelling, bruising, and weakness in the leg are also common.
Recovery depends on severity. A mild or moderate strain (grade 1 or 2) generally heals in one to two months with rest, ice, and gradual rehabilitation. A severe strain, where the muscle is completely torn, or a chronic strain from repeated injuries to the same muscle, can take several months.
Sports Hernia (Athletic Pubalgia)
Despite its name, a sports hernia isn’t actually a hernia. There’s no visible bulge. Instead, it’s a tear or stretch in the soft tissues of the lower abdomen or upper inner thigh, right where the abdominal and thigh muscles attach to the pubic bone. The oblique muscles in the lower abdomen are most frequently affected, and in many cases the adductor tendons are also stretched or torn.
This injury shows up most in sports that involve planting and twisting, like hockey, soccer, wrestling, and football. The pain typically comes on gradually, worsens during activity, and eases with rest, only to return as soon as you start playing again. It can be tricky to diagnose because it overlaps with other causes of groin pain and doesn’t show up on standard imaging as clearly as a true hernia.
Hip Impingement
The hip joint sits close to the groin, and problems inside the joint frequently present as groin pain rather than pain on the side of the hip where most people expect it. Femoroacetabular impingement (FAI) is one of the more common hip-related causes. It happens when extra bone growth along the edge of the hip socket or the top of the thighbone creates an abnormal fit, causing the bones to pinch against each other during movement.
There are two patterns. In one, the thighbone has an irregular shape at the neck, reducing the clearance between it and the socket. In the other, the socket itself extends too far over the ball of the thighbone. Many people have a combination of both. The result is groin pain that gets worse with deep flexion of the hip, such as squatting, sitting for long periods, or getting in and out of a car. You may also notice a gradual loss of range of motion, particularly when rotating the leg inward.
Chronic Pelvic Pain Syndrome
Chronic prostatitis, more accurately called chronic pelvic pain syndrome (CP/CPPS), is defined by pain or discomfort in the pelvic region lasting at least three months within a six-month period, with no identifiable infection or other clear cause. The pain can show up in several places: the area between the scrotum and anus, the lower abdomen, both testicles, or the penis. It often worsens during urination or ejaculation and is frequently accompanied by sexual difficulties.
The pain doesn’t always stay in the pelvis. About 70% of men with chronic pelvic pain also report pain outside the pelvic area. Those with more widespread pain tend to experience worse sleep, more depression and anxiety, and lower quality of life than men whose pain stays localized. CP/CPPS is a diagnosis of exclusion, meaning it’s only identified after ruling out infections, cancer, nerve disease, and structural problems in the urinary tract.
Nerve Entrapment
A nerve called the ilioinguinal nerve runs through the groin area, and it can become compressed or irritated, particularly after lower abdominal surgery, by scar tissue, or from repetitive strain. When this nerve is trapped, you may feel burning, tingling, or unusual sensitivity along the crease of the groin near the inguinal ligament. Some people experience numbness instead of, or alternating with, heightened sensitivity. In about 75% of cases, pressing on the spot where the nerve exits the inguinal canal reproduces the pain.
This type of groin pain can be frustrating because it doesn’t always show up on imaging. It’s typically diagnosed based on the pattern of symptoms and a physical exam that maps where the pain and sensory changes are located.
Testicular Torsion and Epididymitis
Two testicular conditions can cause pain that radiates into the groin, and telling them apart matters because one is a surgical emergency.
Testicular torsion occurs when the spermatic cord twists, cutting off blood flow to the testicle. The pain is sudden and severe, usually on one side. If it isn’t treated within six to eight hours, permanent damage to the testicle becomes increasingly likely with each passing hour. Surgery is almost always required to untwist the cord and secure the testicle so it can’t twist again.
Epididymitis, an infection or inflammation of the coiled tube behind the testicle, can look similar: one-sided scrotal pain with swelling. The key difference is the timeline. Epididymitis pain builds gradually over hours to days rather than hitting all at once. It’s typically treated with anti-inflammatory medications and, if an infection is present, antibiotics.
When Groin Pain Is an Emergency
Most groin pain is not dangerous, but certain combinations of symptoms signal something that needs immediate evaluation. Sudden, severe testicle pain on its own warrants an emergency visit because of the possibility of torsion. Groin pain accompanied by back, abdominal, or chest pain can indicate a serious vascular or abdominal problem. And testicular pain combined with nausea, vomiting, fever, chills, unexplained weight loss, or blood in the urine also requires urgent attention.
How the Source of Pain Is Identified
Because so many structures are packed into the groin region, pinpointing the cause often starts with a hands-on exam. For suspected muscle injuries, a clinician will press along the inner thigh muscles and ask you to squeeze your legs together against resistance. Pain with squeezing points toward the adductors. For a possible hernia, they’ll feel along the inguinal canal and have you cough, looking for a bulge or tenderness.
If hip impingement is on the table, two specific maneuvers help. In one, the leg is flexed at the hip, pulled across the body, and rotated inward. In the other, the leg is positioned in a figure-four shape and gently pressed down. Pain during either of these movements suggests something inside the hip joint is responsible. Hip flexor problems are tested by pressing on the deep muscles at the front of the hip and asking you to lift the leg against resistance.
Imaging comes next when the physical exam narrows things down. Standard X-rays can reveal hip impingement or arthritis. Ultrasound is often the first step for hernias and testicular concerns. MRI may be needed for soft tissue injuries like sports hernias that don’t show up on other imaging.