There is a persistent myth that hernias are 'a man's problem'. They are not — but they do behave differently in women. The bulge is often invisible, the pain is more diffuse, and femoral hernias (much commoner in women) sit deeper in the groin and are easily mistaken for hip or gynaecological pain. As a result, women are far more likely to have their hernia diagnosis delayed and to present as emergencies with strangulation. This guide explains what's different and how a female-led surgical team approaches the problem.
Why hernias in women are different
The female pelvis is wider and the femoral canal is larger relative to body size, which is why femoral hernias are 4× more common in women. The bulge is often deep to the inguinal ligament and not visible from outside.
Common symptoms in women
- •Dragging or burning ache in the groin or lower abdomen
- •Pain worse at the end of the day or after standing
- •Pain into the inner thigh or labia
- •A small, intermittent lump that comes and goes
- •Pain on coughing, sneezing or lifting children
- •Often mistaken for hip pain, ovarian cyst or back pain
Why diagnosis is missed
- •No visible bulge on standard examination
- •Symptoms attributed to gynaecological or musculoskeletal causes
- •Static ultrasound missing dynamic defects
- •Embarrassment or hesitation around male examiners
How we diagnose
- •Detailed history and examination — including standing, coughing, straining
- •Dynamic ultrasound with Valsalva manoeuvre
- •MRI pelvis if ultrasound inconclusive
- •Exclusion of gynaecological and hip causes
Treatment
Laparoscopic TAPP or TEP repair is the preferred approach in women because it covers inguinal, femoral and obturator defects through the same operation. Day-care surgery with same-day discharge is standard.
Femoral hernias should be repaired soon after diagnosis because their strangulation risk is the highest of all groin hernias.