Hernia in Women: Why It Is Often Missed and Why It Should Not Be

When most people hear the word hernia, they picture a man with a bulge in his groin. This association is so common that hernia in women is frequently overlooked — by patients themselves, and sometimes even during initial medical assessments. Women may attribute their symptoms to gynaecological problems, muscle strain, or digestive issues and delay seeking a surgical opinion for months or even years.

1. Do Women Get Hernias?

Yes — and more commonly than many people realise.

While inguinal hernias are more common in men overall, women develop several types of hernia that are clinically important. Some of these are proportionally more common in women than in men. The anatomy of the female pelvis and abdominal wall, the physical demands of pregnancy and childbirth, hormonal effects on connective tissue, and previous abdominal surgery all contribute to hernia development in women.

2. Types of Hernia That Commonly Affect Women

3. Why Is Hernia in Women So Often Missed?

This is one of the most important questions in this blog — because a missed diagnosis means delayed treatment and increased risk.

1. No Visible Bulge

   In men, an inguinal hernia often produces a visible and palpable bulge in the groin that both the patient and the doctor can see and feel. In women, the hernia sac may be smaller, the anatomy is different, and a bulge may not be apparent — especially with femoral hernias, which sit in a deeper anatomical location. A woman may have a hernia causing significant pain with no external swelling at all.

2. Symptoms Mistaken for Gynaecological Problems

   Groin pain in women has a broad differential diagnosis. Ovarian cysts, endometriosis, round ligament pain during pregnancy, and other gynaecological conditions can all produce pain in the groin or lower abdomen. This overlap means that women with hernia pain may be investigated and treated for gynaecological conditions first, with the hernia identified only after a prolonged delay.

3. Pain Without a Lump Is Dismissed

   Because the popular image of a hernia involves a visible lump, women who present with groin pain but no obvious swelling may not be immediately referred for a surgical assessment. The pain may be attributed to muscle strain, hip problems, or other causes before hernia is considered.

4. Femoral Hernias Are Easily Overlooked on Examination

   A femoral hernia sits below the groin crease in a deeper location. It may be small, not easily visible, and can be missed on a routine physical examination unless specifically looked for. This is why clinical suspicion and appropriate imaging are important when a woman presents with unexplained groin pain.

5. Women May Dismiss or Delay Symptoms

   Many women manage competing household and work responsibilities and tend to delay seeking medical care for their own symptoms. A vague groin ache that comes and goes may be tolerated for months before a consultation is sought.

4. What Symptoms Should Women Watch For?

Because a visible bulge may not always be present, women should be aware of a broader range of symptoms that can indicate a hernia.

Seek urgent attention if you develop:

• Sudden severe pain in the groin or abdomen
• A lump that becomes hard, tender, or cannot be pushed back in
• Nausea or vomiting associated with groin or abdominal pain
• Abdominal bloating or inability to pass wind or stool

These symptoms can indicate a trapped or strangulated hernia, which is a surgical emergency requiring immediate assessment.

5. How Is Hernia Diagnosed and Treated in Women?

Diagnosis

Because hernia in women can be subtle, diagnosis may require more than a physical examination alone. If a hernia is suspected but not clearly felt on examination, imaging may be requested.

Ultrasound is commonly used as an initial investigation for groin pain and can identify many hernias. In cases where the diagnosis remains uncertain or surgical planning requires more detail, an MRI scan can provide excellent images of the groin and pelvic anatomy.

An experienced General Surgeon will take a detailed history, perform a careful examination, and request appropriate imaging before confirming the diagnosis.

Treatment — Laparoscopic Hernia Repair

Once a hernia is confirmed and repair is recommended, laparoscopic hernia repair is generally the preferred approach for many hernias in women — including inguinal and femoral hernias.

In laparoscopic hernia repair, the surgeon works through small port incisions using a camera and specialised instruments. For inguinal and femoral hernias, the repair is performed from inside the abdomen, allowing the surgeon to directly visualise and repair the defect. A surgical mesh is typically placed to reinforce the repair.

6. Patient Guide: What Should Women Do If They Suspect a Hernia?

• Do not dismiss persistent groin pain: Groin or lower abdominal pain that recurs with activity — particularly if it is relieved by rest — deserves a surgical assessment, even if there is no visible lump.
• Request a surgical opinion specifically: If you have been investigated for gynaecological causes without a clear explanation for your groin pain, ask for a referral to a General Surgeon for a hernia assessment.
• Do not delay if symptoms are worsening: A hernia that is causing increasing pain, or a lump that is becoming harder to push back in, needs timely assessment.
• Mention any previous abdominal surgery: History of caesarean section, hysterectomy, or other abdominal operations is important information for the surgeon.
• Seek urgent attention for sudden severe pain: A sudden change in symptoms — particularly severe pain with a hard, non-reducible lump — requires immediate medical assessment.