Bilateral groin pain in women can stem from a surprisingly wide range of causes, from strained muscles and worn hip joints to hormonal conditions and inflammatory diseases. Because the groin sits at a crossroads where the lower abdomen, pelvis, and thigh all converge, pain felt on both sides often points toward a central or systemic problem rather than a one-sided injury. Sorting through the possibilities matters, because some causes are benign and self-limiting while others need urgent attention.
Why Both Sides Hurt at Once
When groin pain is only on one side, the list of suspects is long but usually narrowed by location. When both sides hurt, the field shifts. Bilateral pain tends to implicate structures that sit along the midline or span both halves of the pelvis: the pubic symphysis, the lower abdominal wall, the hip joints, or the adductor tendons where they attach near the pubic bone. Systemic inflammatory conditions that affect multiple joints simultaneously can also produce symmetric groin pain. The pattern alone does not clinch a diagnosis, but it does help a clinician prioritize which causes to investigate first.
Musculoskeletal Causes
Hip Osteoarthritis
Hip osteoarthritis is one of the most common reasons women develop groin pain, and when both hips are affected the discomfort often shows up on both sides. Among patients who visit a primary care physician with hip or groin pain, roughly a third have radiographic evidence of osteoarthritis in the affected hip.1JAMA. Does This Patient Have Hip Osteoarthritis? The Rational Clinical Examination Systematic Review The pain tends to be deep, felt in the front of the groin, and worsened by weight-bearing activities like climbing stairs or getting out of a chair. Reduced internal rotation of the hip and groin pain when the leg is moved inward or outward are among the most useful examination findings for spotting osteoarthritis clinically.2JAMA. Does This Patient Have Hip Osteoarthritis? The Rational Clinical Examination Systematic Review
Femoroacetabular Impingement and Labral Tears
In younger women, a structural mismatch between the ball and socket of the hip joint, known as femoroacetabular impingement syndrome, can cause groin pain that worsens with prolonged sitting or deep squatting. The condition frequently involves a tear of the labrum, the cartilage ring that cushions the hip socket. An interesting wrinkle for women is that hip pain levels in those with this condition can fluctuate across the menstrual cycle, suggesting hormonal shifts play a role in how intensely the pain is felt.3PubMed Central. Hip pain level variation in female femoroacetabular impingement syndrome patients in menstrual cycle This is worth knowing, because a woman who notices her groin pain flares around her period might assume it is purely gynecological when a hip problem is actually driving it.
Adductor Tendinopathy
The adductor longus muscle runs from the pubic bone down the inner thigh, and its tendon is the most frequent source of adductor-related groin pain. Diagnosis relies on imaging, but a tricky detail is that abnormal-looking tendons, including calcifications and small cortical erosions, are common even in people with no symptoms, especially athletes. The most reliable sign that the tendon is truly the source of pain is an actual tear within the tendon itself.4PubMed. Imaging of adductor-related groin pain Since you have adductor tendons on both sides, activities that stress both groins equally, like running, ice skating, or horseback riding, can produce bilateral symptoms.
Athletic Pubalgia and Osteitis Pubis
These two conditions overlap considerably and are both centered on the pubic symphysis, the joint at the very front of the pelvis. Osteitis pubis is an overuse syndrome driven by repetitive stress on the pubic bones, commonly seen in athletes who do a lot of kicking, twisting, or cutting movements.5PubMed Central. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach Because the pubic symphysis sits right at the midline, the pain is inherently bilateral or at least central, often radiating into both groins.
Athletic pubalgia, sometimes called a “sports hernia,” involves damage to the muscles and connective tissue that attach to the front of the pelvis. A study of women with this condition found that the most common complaints were lower abdominal pain, a burning sensation in the pelvic or pubic area, and pulling or pain along the adductor muscles. The average duration of symptoms before these women were even evaluated was nearly three years, with some waiting as long as twelve years for a diagnosis.6PubMed Central. Athletic Pubalgia Among Women That delay is partly because athletic pubalgia has historically been studied almost entirely in men, making clinicians slower to consider it in women.
Hernias
Groin hernias in women are less common than in men, but they are far from rare and they are more likely to be missed. In a review of over 250 women who had groin hernia repairs, the majority of hernias were indirect inguinal hernias, but about one in five was a femoral hernia, a type that is uncommon in men and carries a higher risk of becoming trapped or strangulated.7Hernia. Groin hernias in women In some of those cases, the only preoperative finding was discomfort with no visible swelling at all. That matters because the classic teaching about hernias emphasizes a visible bulge, which women with groin hernias may not have. Bilateral inguinal hernias can occur, and when they do, the symmetric groin pain they cause can be confused with other pelvic conditions.
Women who experience groin pain that has been dismissed or left unexplained often face considerable frustration. Research into patient experiences highlights that females with groin hernias frequently encounter delays in diagnosis, partly because clinicians are less likely to suspect a hernia in a woman than in a man presenting with the same symptoms.8PubMed Central. Understanding patient experiences to improve care for females groin hernia
Pregnancy-Related Pelvic Girdle Pain
Pelvic girdle pain during or after pregnancy is extremely common and is one of the leading causes of bilateral groin discomfort in women of childbearing age. The pain can localize to the front of the pelvis, the back of the pelvis near the sacroiliac joints, or both, and it often radiates across the hip joint and into the thigh bones. It can begin as early as the first trimester, during labor, or even in the postpartum period.9PubMed Central. Pregnancy-related pelvic girdle pain: an update The hormonal changes of pregnancy, particularly the surge in relaxin that loosens ligaments in preparation for delivery, make the pelvic joints more mobile and more vulnerable to strain.
What catches many women off guard is that pelvic girdle pain can persist for months after delivery, and in a minority of cases it becomes a long-term issue. If you are experiencing groin pain that started during pregnancy and has not resolved postpartum, it is worth seeking a targeted assessment rather than assuming it will eventually fade on its own. Physiotherapy focused on pelvic stability exercises is one of the best-studied treatments, though recovery timelines vary widely.
Gynecological Causes
Because the groin is so close to the reproductive organs, gynecological conditions can produce groin pain that is easy to confuse with musculoskeletal problems. One uncommon but underdiagnosed example is inguinal endometriosis, where endometrial tissue grows in or near the inguinal canal. It typically presents as a painful groin mass in women of reproductive age, with pain that worsens during menstruation. It is frequently misdiagnosed as an inguinal hernia, and confirmation usually requires surgical excision and tissue analysis.10Europe PMC. Inguinal Endometriosis: An Unusual Cause of Groin Pain Inguinal endometriosis is typically one-sided, so if you have bilateral groin pain that clearly tracks with your menstrual cycle, the more likely culprit is a pelvic source of endometriosis referring pain outward to the groins.
Ovarian torsion is a gynecological emergency that can occasionally mimic groin pain, though it is usually unilateral and comes on suddenly. The hallmark symptoms are acute-onset pelvic pain with nausea and vomiting. The main risk factor is having an ovarian mass, and the condition occurs in roughly 2 to 15 percent of patients undergoing surgical treatment for such masses.11Europe PMC. A review of ovary torsion Bilateral ovarian torsion happening simultaneously is vanishingly rare, so this diagnosis is more relevant as a red flag to rule out when one side hurts acutely than as an explanation for chronic bilateral symptoms.
Nerve Entrapment
Several nerves pass through the groin region and can become irritated or trapped, producing chronic pain that does not respond to typical musculoskeletal treatments. The nerves most commonly involved are the ilioinguinal, iliohypogastric, genitofemoral, and lateral femoral cutaneous nerves. In a surgical series of 54 patients treated for groin pain of nerve origin, some had bilateral symptoms, and the diagnosis was made primarily through careful history and physical examination rather than imaging.12PubMed. Surgical management of groin pain of neural origin The pain from nerve entrapment tends to be burning, shooting, or tingling rather than the deep ache of joint or tendon problems, and it can be provoked by specific postures or by pressure over the nerve’s path.
Nerve entrapment in the groin can follow abdominal or pelvic surgery, including cesarean sections and hernia repairs. Tight clothing, weight gain, and prolonged positions that compress the inguinal area are also triggers. Because it is a diagnosis of exclusion that does not show up on standard imaging, nerve entrapment is frequently the last thing considered after other causes have been ruled out, leading to long diagnostic odysseys for some patients.
Inflammatory and Rheumatological Conditions
When bilateral groin pain appears alongside stiffness that is worst in the morning and improves with movement, an inflammatory condition involving the spine or pelvis deserves consideration. Axial spondyloarthritis is one such condition, and it has a particular tendency to affect the pelvic region. In patients with radiographic axial spondyloarthritis, bilateral entheseal lesions, meaning inflammation at the points where tendons and ligaments attach to bone around the pelvis, were significantly more common than in matched controls.13PubMed Central. Radiographic entheseal lesions of the pelvic region are more prevalent in radiographic axSpA than in age- and sex-matched controls and are associated with more severe spinal disease The most commonly affected site was the ischium (the bone you sit on), and the lesions were associated with more severe spinal disease overall.
Inflammation around the pubic symphysis is another feature of this group of diseases. MRI studies of patients with axial spondyloarthritis have found active inflammatory changes around the pubic symphysis in about 18 percent of cases, including bone marrow swelling and enthesitis.14PubMed. Active inflammatory changes around the pubic symphysis in patients with axial spondyloarthritis These changes were associated with older age and elevated markers of inflammation in the blood. If your bilateral groin pain came on gradually, you also have back stiffness, and the pain eases with activity rather than rest, raising the possibility of spondyloarthritis with your doctor is worthwhile.
When to Seek Urgent Care
Most causes of bilateral groin pain are not emergencies, but a few demand prompt evaluation. You should seek immediate medical attention if you experience:
- Sudden severe pain: Acute onset of intense unilateral or bilateral pelvic or groin pain, especially with nausea and vomiting, raises concern for ovarian torsion, a strangulated hernia, or another surgical emergency.
- Fever with groin pain: Infection of a joint (septic arthritis), a lymph node, or a deeper pelvic structure can produce groin pain with systemic signs of illness.
- Inability to bear weight: If you cannot walk or stand due to groin pain, a stress fracture of the femoral neck or pelvis needs to be ruled out. These fractures can worsen rapidly without treatment.
- A firm, non-reducible groin lump: A hernia that cannot be pushed back in, especially with pain and skin color changes, may be incarcerated or strangulated and needs emergency surgical evaluation.
Stress fractures of the pelvis and femoral neck are a particular concern in women with risk factors such as low body weight, menstrual irregularities, or a history of high-impact training. The combination of these factors, sometimes grouped under the concept of relative energy deficiency in sport, weakens bone and makes it vulnerable to fracture under loads that would otherwise be tolerated.
Making Sense of the Diagnostic Workup
Because so many different structures can generate groin pain, imaging plays a central role in sorting out what is going on. MRI is especially helpful when groin pain is poorly localized, since it can evaluate the hip joint, the pubic bones, the rectus and adductor attachments, and surrounding soft tissues all at once.15Sports Health. Imaging of Groin Pain: Magnetic Resonance and Ultrasound Imaging Features Ultrasound has the advantage of being performed in real time, which makes it useful for assessing the pubic region during movement and for guiding injections. Plain X-rays remain useful as a first step for hip osteoarthritis and pubic symphysis changes, though they miss soft-tissue problems entirely.
One thing worth knowing is that imaging often reveals findings that look abnormal but have nothing to do with your pain. Adductor tendon abnormalities, small labral tears, and mild pubic bone irregularities show up commonly in people with no symptoms at all. A skilled clinician will correlate what the imaging shows with what you feel and where you feel it, rather than treating every incidental finding. If you are told you have a labral tear or tendon degeneration on an MRI, that does not automatically mean it is the source of your symptoms.
Sex-Specific Challenges in Diagnosis
Hip and groin pain in women involve a more complex set of possible diagnoses than in men, partly because of anatomy and partly because of hormonal influences. The differential diagnosis in female athletes, for example, includes not only the standard musculoskeletal suspects but also labral tears related to hip dysplasia, hypermobility syndromes, pelvic floor dysfunction, and conditions influenced by the menstrual cycle.16ScienceDirect. Chapter 9 – Differential diagnosis—Is it the pelvic floor, the hip, or the groin? Despite this broader range of possibilities, much of the research on groin pain has historically focused on male athletes, meaning the clinical tools and decision rules used in practice were developed for a population that may not match yours.
The result, in practical terms, is that women with groin pain are more likely to experience diagnostic delays. The nearly three-year average symptom duration before evaluation seen in women with athletic pubalgia illustrates how long the process can take.17PubMed Central. Athletic Pubalgia Among Women If you have been told your groin pain is “probably muscular” or “nothing to worry about” but it persists, pushing for a more thorough evaluation, including imaging and possibly referral to a specialist familiar with female pelvic and hip pathology, is a reasonable next step.
Pelvic Floor Dysfunction as an Overlooked Contributor
The pelvic floor muscles form a sling at the base of the pelvis that supports the bladder, uterus, and rectum. When these muscles are too tight, too weak, or poorly coordinated, they can refer pain into the groin on both sides. This is distinct from the musculoskeletal and joint causes described above, though the two can coexist. Pelvic floor dysfunction is especially common after childbirth, pelvic surgery, or prolonged high-impact exercise, and it can produce a constellation of symptoms beyond pain, including urinary urgency, difficulty emptying the bladder, and discomfort during intercourse.
What makes pelvic floor dysfunction tricky is that it does not show up on standard imaging. Diagnosis typically requires a physical examination by a clinician trained in pelvic floor assessment, often a pelvic health physiotherapist. If your bilateral groin pain has resisted standard treatments and imaging has not turned up a clear structural cause, a pelvic floor evaluation may be the missing piece. Treatment usually involves targeted exercises and manual therapy rather than surgery, and many women see improvement within a few months of focused rehabilitation.