What Can Cause Pain in Groin Area?

The skin and deeper tissue of groin receives sensory nerves from first lumbar spinal nerve. Similarly, sacral sensory nerve S2 and S3 supplies sensory nerve to the skin and deeper tissue of penis and scrotum. Sensory nerve carries impulses of touch, temperature changes and pain to spinal cord and next to brain. The groin sensory nerve of spinal segment L1 travels along genitofemoral and ilio-inguinal nerve from spinal cord to groin. The sensory branches of S2 and S3 sacral spinal nerve passes through pudendal nerve to the skin and deeper tissue of penis and scrotum. The penile and scrotal pain in few cases is also referred to as groin pain despite no abnormalities observed in L1 spinal nerve.

The pain in groin are as well as penile and scrotal pain is caused by diseases of skin, subcutaneous tissue, lymph node and spread of cancer tissue. The ultrasound examination helps to diagnose groin, penile or scrotal pain caused by cancer, enlarged lymph node, hernia and hydrocele. The cause of radicular pain is diagnosed by radiological studies. The radicular pain involving L1 nerve spreads over groin and S2 and S3 nerve spreads over penis and scrotum.

The pain in groin area is caused by diseases of skin, subcutaneous tissue, lymph node and cancer. Infection spread over groin resulting in cellulitis, boil or furuncle causes severe groin pain. The inguinal hernia and groin muscle spasm causes pain that is mostly localized over groin area. Groin muscle pain is frequently caused by muscle spasm or injury of groin muscle. The pain in groin area is also caused by nerve lesions such as peripheral neuropathy or radiculopathy.

Radicular pain in groin, penis or scrotum is caused by irritation or pinch of spinal nerve within spinal canal, spinal foramina or somewhere along the course of the nerve to groin. Abnormal hip joint causes moderate to severe pain in groin area, which is often spread over area of inguinal and upper anterior thigh. The cause of groin pain is diagnosed by clinical examination that is assisted by radiological, blood or ultrasound test. Radiological study confirms the diagnosis of hip joint disease. Soft tissue diseases or abnormalities such as lymphadenopathy, hernia or cancer is diagnosed and differentiated by ultrasound studies.

The List of Causes of Pain in Groin Area Including Penile and Scrotal Pain are as Follows-

1. Pain in Groin Area Caused Due to Skin Diseases

   1. Cellulitis- The cellulitis infection that spreads through subcutaneous tissue often results in fever and severe groin pain.
   2. Furuncle (Boil)- Furuncle also known as boil is a hair follicle infection. If symptoms of boil spread in groin is neglected then the infection may spread in subcutaneous tissue of groin and become cellulitis. Boil in groin region causes mild to moderate groin pain.
   3. Carbuncle- Carbuncle is wide spread infection caused by multiple boils or spread of furuncle in adjacent skin and subcutaneous tissue. The pain is moderate to severe in intensity.

2. Pain in Groin Area Caused Due to Hip Joint Disease Where Individual is Able to Move the Hip Joint

   1. Hip Joint Arthritis- Mild to severe groin pain is observed in patient suffering with hip joint arthritis caused by systemic disease such as osteoarthritis, rheumatoid arthritis and psoriatic arthritis.
   2. Hip Joint Bursitis- Inflammation of hip joint bursa causes severe groin pain during activities like walking or jogging. The groin pain is severe with activities and mild to moderate at rest.
   3. Hip Joint Subluxation- Partial hip joint dislocation is also known as subluxation. Patient is able to ambulate when pain is mild to moderate with limp. Ambulation or movement of hip joint become restricted when is intolerable and severe. Minor subluxation is often difficult to diagnose with radiological studies.
   4. Hip Joint Hairline Fracture- Hairline fracture may involve pelvic joint socket or femur bone. The fractured bone fragments are intact and align maintaining normal anatomical structure. Hairline fracture of hip joint may cause mild to severe pain and mostly observed during hip joint movements.
   5. Avascular Necrosis of Hip Joint- Avascular necrosis of bones of hip joint is observed when blood supply to hip joint is severely restricted. Patient suffers with severe pain in groin at rest and with activities.

3. Pain in Groin Are Caused Due to Hip Joint Disease Where Individual Is Unable To Move Hip Joint-

   1. Hip Fracture- Displaced hip joint fracture causes severe deformity. The displaced fracture fragments of hip bone protrude through the skin in groin resulting in severe intractable pain in groin area. Individual is unable to move the leg at hip joint.
   2. Hip Joint Dislocation- Hip joint dislocation causes hard and irregular swelling of groin. Dislocated head of femur protrudes under skin of groin. Individuals suffering with hip joint dislocation are unable to move their leg around the hip joint. Hip joint dislocation causes severe pain in groin area.

4. Pain in Groin Area Caused Due to Pelvic Diseases-

   1. Fracture of Pubic Symphysis- Hairline or displaced fracture of pelvic bone causes referred pain over groin area.
   2. Osteitis Pubis– Osteitis pubis is pubic bone inflammatory disease. The pelvic bone inflammation causes mild to severe pain spread over pubic bone and groin.

5. Inguinal and Groin Soft Tissue Diseases That Can Cause Groin Pain-

   • Pulled groin muscles
   • Groin tendonitis
   • Ligamental tear or inflammation
   • Inguinal hernia
   • Groin lymphadenopathy

6. Radicular Pain-

   1. Lumbar Disc Bulge or Herniation at Level L1- Lumbar disc bulge or herniation causes irritation or pinch of L1 lumbar nerve within spinal canal or foramina. The severe pain is transmitted along the course of the nerve. The distal end of pain is felt over groin area. The pain when travels along the course of the nerve is known as radicular pain.
   2. Spinal Stenosis at Level L1- Spinal stenosis at level L1 causes narrowing of the spinal canal, which results in irritation or squeeze of spinal cord at spinal level L1. The irritation or squeeze of spinal cord causes pain spread over multiple segments including groin.
   3. Foraminal Stenosis- The first lumbar spinal nerve passes through first lumbar spinal foramina. The foraminal stenosis or narrowing is caused by collapse of foraminal lumen as observed in patient suffering with disc degeneration or thinning of disc. Similarly, foraminal stenosis is also observed when foraminal lumen become narrow because of part of the lumen is occupied by protruded disc or herniated disc.

7. Pain in Groin Area Caused Due to Peripheral Neuropathy-

   Peripheral neuropathy affects the function of peripheral nerve. First lumbar nerve travels through Genitofemoral and Ilio-inguinal nerve, which carries sensory and motor fibers to and from spinal cord to peripheral tissue. The nerve is considered as a peripheral nerve. The peripheral neuropathy is a condition observed when peripheral nerve suffers with inflammation or degeneration. Most common causes of peripheral neuropathy are diabetes, chronic alcohol intake and vitamin deficiency.

   The List of Causes of Peripheral Neuropathy are as Follows-

   1. Diabetes– The chronic disease like diabetes causes sustained increased of blood sugar in few individuals when treatment is ignored. The persistent high blood sugar causes initial inflammatory changes and later degenerative changes in peripheral nerve. The degenerating peripheral nerve if not treated promptly results in permanent numbness of tissue and weakness of muscles. The most beneficial treatment to prevent peripheral neuropathy in diabetes patient is to keep the blood sugar level near normal level with medications.
   2. Habitual Alcohol Drinking- Chronic regular alcohol intake causes deficiency of B1, B6 and B12 vitamin. The recovery metabolism of nerve is lacking in individual suffering with B-complex vitamin deficiency. The condition results in degenerative changes of sensory nerve to groin. The initial changes of such nerve degeneration causes moderate to severe pain and later numbness with mild or no pain.
   3. Heavy Metal Poisoning Like Lead- Lead poisoning causes irritation of peripheral nerve like Genitofemoral and Ilio-inguinal nerve. The irritation results in continuous moderate to severe pain in groin.
   4. Chemotherapy– The chemotherapy agents like vincrystine and vinblastine causes peripheral neuropathy resulting in moderate to severe groin pain.
   5. Infection- Isolated peripheral neuropathy is rare in patient suffering with infection like HIV and Epstein-Barr virus. The wide spread neuropathy may result in groin pain as well as pain in several other dermatomes. Occasionally in patients suffering with hepatitis C, leprosy and diphtheria isolated nerve lesion may be observed resulting in unilateral or bilateral groin pain.
   6. Autoimmune Disease- Autoimmune diseases may cause regional or generalized neuropathy resulting in groin pain along with wide spread pain in other parts of body. The groin pain may be observed in patient suffering with Sjogren’s syndrome, lupus, Guillain-Barre syndrome and chronic inflammatory demyelinating polyneuropathy.
   7. Systemic Disease- Systemic diseases involving kidney (nephropathy), liver (cirrhosis and hepatitis), connective tissue and thyroid (hypothyroidism) in few cases causes wide spread neuropathy and pain. In few cases these diseases may cause regional peripheral neuropathy involving one or more than one spinal nerve resulting isolated groin pain.

8. Cancer

   Groin pain is caused by skin cancer or enlarged groin lymphnodes secondary to metastasis. The pain is associated with firm to hard mass felt underneath the skin in groin. Pain is moderate to severe in intensity and increase with movement of lower leg. Pain is often unilateral. The primary cancer develops in skin, subcutaneous tissue or muscles like sarcoidosis and squamous cell carcinoma.

   Differential Diagnosis of groin pain is important so as to diagnose and differentiate life threatening and restricting diseases causing pain in groin area. The prompt treatment depends on timely diagnosis of cause of groin pain.

Also Read:

• Groin Pull or Groin Strain: Symptoms, Treatment, Recovery, Prognosis, Prevention
• Groin Inflammation: Causes, Signs, Symptoms, Treatment, Exercises, Investigations
• Groin Pain: Types, Symptoms, Causes, Treatment, Investigations