Inguinal Hernia: Despite two ultrasounds showing no herniation, the symptoms of worsening pain with lifting, walking, coughing, or other Valsalva maneuvers are highly suggestive of an inguinal hernia. It's possible that the hernia is not visible on ultrasound, especially if it's a small or indirect hernia.

Nerve Entrapment or Neuroma: The patient's symptoms could be related to nerve entrapment or neuroma formation following the hysterectomy, which could cause severe tenderness and pain in the groin area.
Musculoskeletal Strain: The patient's history of worsening pain with physical activity suggests a musculoskeletal strain, possibly related to overuse or poor lifting techniques.
Adhesions or Scar Tissue: Post-surgical adhesions or scar tissue could be causing the patient's pain, especially if the adhesions are pulling on surrounding tissues or nerves.

Ovarian Remnant Syndrome: Although rare, ovarian remnant syndrome is a potentially serious condition that can occur after hysterectomy, where residual ovarian tissue causes chronic pain.
Deep Vein Thrombosis (DVT): DVT is a life-threatening condition that can cause severe pain in the groin area, and should be considered in any patient with unexplained pain, especially if there are risk factors such as recent surgery or immobility.
Intra-Abdominal Shunt or Vascular Injury: Although unlikely, an intra-abdominal shunt or vascular injury could be causing the patient's pain, and would require prompt surgical intervention.

Spigelian Hernia: A Spigelian hernia is a rare type of hernia that occurs through the spigelian fascia, and could cause groin pain.
Groin Lipoma or Soft Tissue Tumor: A lipoma or soft tissue tumor in the groin area could cause pain and tenderness, although this would likely be visible on ultrasound.
Pudendal Neuralgia: Pudendal neuralgia is a rare condition characterized by chronic pain in the distribution of the pudendal nerve, which could cause groin pain.