Groin Pain in Women: 5 Causes That Aren't a Pulled Muscle

You know the pattern. You feel a pull in your groin, you decide you must have tweaked something, and you stretch it. It backs off for a day or two, and then it comes right back on the same stairs, or the same side sleeping position, or the same third mile of a run. If you have been chasing a "pulled muscle" in your groin for longer than a few weeks and it keeps coming back, I want you to know that groin pain in women has a longer list of causes than most people are given, and a strain is often not the one I find.

Why is groin pain in women so confusing to pin down?

Your inner thigh muscles, your hip joint, your pubic bone and your pelvic floor all converge in an area about the size of your palm, and several of them share nerve supply. So a single ache in that spot can honestly come from four or five different structures, and they all feel roughly the same to the person living with it.

This is confusing enough that sports medicine needed a summit to sort it out. In 2014 a group of twenty-four international experts met in Doha and agreed to split groin pain into defined categories, including adductor-related, iliopsoas-related, pubic-related, inguinal-related and hip-related pain [1]. That agreement exists because clinicians kept giving the same complaint different names. If the professionals needed a consensus meeting, you are allowed to be confused too.

Here are the five causes I see most often in my practice that are not a pulled muscle.

1. Your obturator internus is working overtime

The obturator internus is a hip rotator, and it is also considered part of the pelvic floor group. It sits right next to the levator ani muscles, which is why tension in one so often travels to the other, and why irritation there refers into the deep groin, the hip and sometimes the low back [2].

The story I hear is a deep ache rather than a sharp pull. It is worse after a long drive or a long day at a desk, it does not respond much to stretching the inner thigh, and it can ache when you sit on a hard chair. When I palpate this muscle internally, most people are genuinely surprised, because they have been treating the front of their thigh for months and the tender spot is somewhere they never thought to look.

2. Pelvic floor trigger points that refer into the groin

Myofascial pelvic pain is exactly what it sounds like: tender, guarded muscle in the pelvic floor with trigger points that send pain somewhere else, often forward into the groin. Estimates of how common it is among women with chronic pelvic pain range from about 14 to 23 percent on the low end to as high as 78 percent among women with interstitial cystitis [3].

Here is the part that frustrates me. The same review points out that very few providers actually palpate the pelvic floor muscles during a routine gynecological exam to check for this [3]. So if your imaging is clean and your labs are clean and you have been told everything looks normal, it is entirely possible that the tissue causing your pain was never examined. That is not a knock on your doctor, it is just outside what a standard exam covers.

3. Pubic symphysis and pelvic girdle pain

If your groin pain showed up during pregnancy or after a delivery, this is where I look first. Pelvic girdle pain centers on the joints of the pelvis, most often the pubic symphysis at the front and the sacroiliac joints at the back, and it tends to flare with the one-sided things: rolling over in bed, stairs, standing on one leg to get dressed, getting in and out of the car.

It is far from rare. In one prospective Polish cohort of 411 women, almost half reported pelvic girdle pain symptoms at some point during pregnancy, and about 16 percent still reported symptoms six weeks postpartum [4]. If that is you, our pregnancy pelvic floor guide walks through what is safe and when to start.

4. Endometriosis wearing a pulled-muscle costume

Endometriosis can present as groin and inner thigh pain, and it often brings a pattern with it: the pain tracks your cycle, or it is noticeably worse around your period, or it has slowly gotten worse over years rather than starting on one specific day.

The timeline here is the hard part. A 2026 study of nearly 7,000 women found an average diagnostic delay of about ten years for endometriosis [5]. Ten years of being told to stretch more. If any of that pattern sounds familiar, read what physical therapy can and cannot do for endometriosis, because I am honest in that piece about where our lane ends and where you need a gynecologist alongside us.

5. A nerve, not a muscle

The ilioinguinal, genitofemoral and pudendal nerves all run through this neighborhood, and when one of them is irritated the pain has a different flavor entirely. Instead of a dull ache you get burning, tingling, numbness, or a zap that shoots down the inner thigh. It often does not care much whether you are moving or resting, which is a useful clue, because a strained muscle usually has a clear position that calms it down.

Nerve-driven pelvic pain is very treatable, and it is also very commonly missed for years. Pudendal neuralgia is the example I go back to.

When it is genuinely not your pelvic floor

I want to be balanced here, because sometimes groin pain is exactly what it looks like, and sometimes it belongs to a different provider entirely. Watch for these:

• A true adductor strain usually has a moment. You can point to the sprint, the slip, or the kick where it happened, and it was sharply painful right then.
• A hernia deserves a mention on its own. Groin hernias in women tend to be smaller and harder to feel than in men, and in one study of 87 women with groin pain and a normal physical exam, ultrasound still found occult hernias and other findings [6]. A normal exam alone does not rule one out.
• A bulge, fever, nausea, or pain that is escalating quickly is a call to your physician, not a scheduling question for me.

If you have a hip that clicks, catches or locks, that is worth an orthopedic look as well. Pelvic floor therapy and an orthopedic workup are not competing options, and I am happy to work alongside whoever else is on your team.

What I actually check at a first visit

I start on the outside, because it is the least invasive place to get information. I look at how you load one leg, what your adductors and hip rotators feel like, and whether your pubic symphysis is tender to gentle pressure. I ask about your cycle, your bladder and your bowels, because those answers narrow things down fast.

In my practice, I only move to an internal exam when it is going to change the plan, and only with your consent, and we can absolutely spend the first session entirely externally if that is what feels right to you. Nothing about this has to happen on a schedule that is not yours.

If you want more background on what these sessions look like before you book anything, start with what pelvic floor physical therapy actually is, or read what is actually causing your pelvic pain for the wider picture.

You do not have to keep guessing

Groin pain that keeps coming back after rest and stretching is information, not a personal failure. It usually means the thing generating the pain has not been examined yet, and that is a solvable problem.

If this has been going on for months, let's take a look together. You can reach Protea Physical Therapy at (909) 265-3584, and we are here in Anaheim Hills serving Orange County.

References

1. Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 2015;49(12):768-774. https://pubmed.ncbi.nlm.nih.gov/26031643/
2. Michaud T. Obturator internus contracture: an underappreciated cause of pelvic floor and sciatic pain. Journal of Contemporary Chiropractic. 2024;7(1):168-172. https://journal.parker.edu/article/125098-obturator-internus-contracture-an-underappreciated-cause-of-pelvic-floor-and-sciatic-pain
3. Pastore EA, Katzman WB. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2012;41(5):680-691. https://pmc.ncbi.nlm.nih.gov/articles/PMC3492521/
4. Starzec-Proserpio M, Węgrzynowska M, Sys D, et al. Prevalence and factors associated with postpartum pelvic girdle pain among women in Poland: a prospective, observational study. BMC Musculoskeletal Disorders. 2022;23:928. https://pmc.ncbi.nlm.nih.gov/articles/PMC9585777/
5. Breton Z, Gouesbet S, Indersie E, et al. Endometriosis diagnostic delay and its correlates: results from the ComPaRe-Endometriosis cohort. Journal of Women's Health. 2026. https://pubmed.ncbi.nlm.nih.gov/40999898/
6. Grant T, Neuschler E, Hartz W. Groin pain in women: use of sonography to detect occult hernias. Journal of Ultrasound in Medicine. 2011;30:1701-1707. https://pubmed.ncbi.nlm.nih.gov/22124006/

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This article is for educational purposes and is not medical advice. Please consult a healthcare provider about your own symptoms.