Most Common Hernia in Women
The most common hernia in women is inguinal hernia (answer c). While femoral hernias are more common in women than men proportionally, inguinal hernias still represent the overall most frequent type of hernia in the female population 1.
Epidemiology of Hernias in Women
- Inguinal hernias are the most common type of hernia in women, with bilateral primary indirect inguinal hernias being the most frequent presentation 2
- Femoral hernias occur more frequently in women compared to men, but are still less common overall than inguinal hernias 3
- Bilateral primary femoral hernias are quite rare in women 2
- Bilateral primary direct inguinal hernias are even more uncommon in the female population 2
Anatomical Considerations
- The female anatomy provides a stronger posterior wall of the inguinal canal compared to males, which contributes to the lower overall incidence of hernias in women 2
- In women, the gubernaculum does not thicken but persists as the ovarian round ligament, unlike in males where it attaches the testis to the scrotum 4
- The craniosuspensory ligament is maintained in females, allowing the ovary to retain its dorsal (retroperitoneal) position 4
Risk Factors for Hernias in Women
- Positive family history is a significant independent risk factor for inguinal hernia in women (OR = 4.3) 1
- Chronic constipation increases risk (OR = 2.5) 1
- Obesity (BMI > 30) appears to be protective against inguinal hernia development in women (OR = 0.2) 1
- Regular sports activity may reduce risk by strengthening abdominal musculature (OR = 0.2) 1
- Unlike in men, smoking and previous abdominal surgeries (including appendectomy) do not appear to be significant risk factors for women 1
Clinical Implications
- All inguinal hernias in women should be surgically repaired, unlike in men where watchful waiting may be appropriate for asymptomatic hernias 5
- Women have a slightly higher reoperation rate (4.3%) compared to men (3.1%) following inguinal hernia repair 3
- A significant finding is that 41.5% of reoperations in women reveal a femoral hernia, compared to only 5.4% in men 3
- This suggests that exploration of the femoral canal should be considered during primary inguinal hernia repair in women 3
Diagnostic Considerations
- Physical examination is usually sufficient for diagnosis, looking for a bulge or impulse while the patient coughs or strains 6
- Symptomatic patients often present with groin pain, which may be severe 6
- A burning, gurgling, or aching sensation in the groin, with a heavy or dragging feeling that worsens toward the end of the day is common 6
- Ultrasonography may be indicated when the diagnosis is uncertain, especially with nonpalpable but symptomatic hernias 6, 1
Surgical Management
- For bilateral hernias in women, a laparoscopic or endoscopic procedure is generally preferable to an open procedure 5
- Mesh-based repair is recommended for most hernia repairs 5
- The reoperation rate appears to be independent of the type of surgical repair technique used 3
The higher rate of femoral hernias found during reoperation in women highlights the importance of thorough evaluation of the femoral canal during the initial surgery, as missed femoral hernias may be a significant cause of recurrence in the female population 3.