Two kinds of groin hernia
A groin hernia is a bulge of fat or bowel through a weak point low in the abdominal wall. There are two main kinds. An inguinal hernia comes through the inguinal canal, above the crease of the groin; it is by far the commonest hernia in both sexes, and that includes women. A femoral hernia comes through the femoral canal, a narrow gap just below the groin crease, beside the main vessels to the leg. Femoral hernias are much less common overall, but they occur more often in women than in men. I have written about each in more detail on my practice site: inguinal hernia and femoral hernia.
Why the difference matters
The femoral canal is tight and unforgiving. A hernia through it is more likely to become trapped, and once trapped, more likely to cut off the blood supply to the bowel inside it. This is why femoral hernias are usually repaired promptly rather than watched.
The best large study of women's groin hernias comes from the Swedish Hernia Register, which followed 6,895 repairs in women over 11 years. Women made up about 8 per cent of groin hernia repairs. Compared with men, a much higher share of their operations were emergencies: 16.9 per cent against 5.0 per cent. And when women needed a second operation for a "recurrence", a femoral hernia was found in 41.6 per cent of those originally diagnosed with an inguinal hernia, compared with 4.6 per cent of men.2
The most likely explanation for that last figure is not that the first repair failed, but that a femoral hernia was there all along, either missed or in a place the first operation never covered.
Getting the diagnosis right
Telling an inguinal from a femoral hernia by examination alone can be difficult, particularly in women, in whom groin hernias are often small, soft and intermittent. Other things cause groin lumps and groin pain in women too: lymph nodes, swellings of the round ligament (especially in pregnancy), and pain from the hip or the pelvis. An ultrasound is often helpful when the examination is uncertain. I have written separately on whether you need a scan for a groin hernia.
Why keyhole repair is usually advised for women
The international guidelines for groin hernia management, written by the HerniaSurge group, suggest that women with groin hernias have a laparo-endoscopic (keyhole) repair, provided the surgeon has the expertise. Their reasoning is the one above: from the inside, the surgeon can see the inguinal and femoral openings at once, find a femoral hernia that was not suspected, and cover all of them with one mesh. The guidelines also give lower chronic pain as a reason.1
The same guidelines list female sex, and a femoral hernia, among the risk factors for a hernia becoming trapped, and suggest timely repair of femoral hernias.1 Keyhole repair is not right for every woman; previous lower abdominal or pelvic surgery, other medical conditions and personal preference all enter the decision, and open repair remains a good operation in the right circumstances. You can read about laparoscopic repair and robotic repair on my practice site.
Recurrent groin hernias in women
If you have had a groin hernia repaired and the lump has come back, the possibility of a femoral hernia should be specifically considered, for the reasons above. A keyhole approach is often well suited to a hernia that recurs after an open repair, because it works through tissue the first operation did not disturb. There is more on this on my page about recurrent hernias.
Sources
- HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1–165. doi:10.1007/s10029-017-1668-x. PMID 29330835.
- Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg. 2005;92(12):1553–8. doi:10.1002/bjs.5156. PMID 16187268.
Questions women ask me
Can a woman get an inguinal hernia?
Yes. Inguinal hernias are the commonest groin hernia in women as well as men. Femoral hernias are relatively more common in women than in men, but even in women most groin hernias are inguinal. The point is to be examined rather than to guess.
Should a groin hernia in a woman be watched rather than repaired?
A confirmed femoral hernia is usually repaired promptly, because of the higher risk of it becoming trapped. In pregnancy, a groin swelling is usually watched, because it is often a swelling of the round ligament that settles after the birth. Otherwise, the decision depends on your symptoms, the type of hernia and your general health, and is one we make together.
Will I need mesh?
For most adult groin hernias, a mesh repair gives the lowest chance of the hernia coming back, and that is what the international guidelines recommend. We will discuss mesh, and the alternatives, in detail before any decision.
Seeing me
HERnia is the name I give to the care of women with hernias and abdominal wall problems. Appointments are made through my practice, and consultations are in Balwyn North, Coburg and Williamstown. A referral from your GP is needed for a specialist consultation to attract a Medicare rebate.
Request an appointmentCall (+61) 493 091 911Written and reviewed by Prof. Ramana Balasubramaniam, general surgeon, Melbourne. Last reviewed 31 October 2026. This page is general information, not medical advice, and it cannot replace an examination. If you have a painful, hard lump that will not go back, with vomiting or severe pain, go to your nearest emergency department.