Can females get inguinal hernias?

Yes, Females Do Get Inguinal Hernias

Yes, females absolutely develop inguinal hernias, though they are less common than in males, with women representing 8.0-11.5% of all operated groin hernias and having a lifetime risk of 3-5.8%. 1

Epidemiology and Gender Differences

• The male-to-female ratio for inguinal hernias is approximately 4.8:1, demonstrating that while less common, inguinal hernias are a significant clinical entity in females 2
• In pediatric populations, more than 90% of inguinal hernias occur in boys, but females still account for a substantial minority of cases 3
• The incidence in term female infants is approximately 3-5%, increasing to 13% in those born before 33 weeks gestation 3, 4

Critical Clinical Distinctions in Females

Higher Risk Profile

• Females have a significantly higher proportion of femoral hernias (16.7-37%) compared to males, which is crucial because femoral hernias carry higher strangulation risk 1
• The emergency surgery rate in women is 14.5-17.0%—three to four times higher than in men—and reaches 40.6% specifically for femoral hernias 1
• Females under 1 year old are particularly susceptible to incarcerated hernias, being up to 60 times more likely to present with incarceration 2

Anatomical Considerations

• In female infants and children, the hernia may extend into the labia (analogous to scrotal extension in males) 3
• Ovarian hernias can occur in females and require special surgical attention 2
• The American Academy of Pediatrics recommends examining for an inguinal bulge that increases with crying or straining and may extend into the labia in females 3

Diagnostic Approach

• Ultrasonography is often needed in women for diagnosis, as groin hernias are less easily diagnosed on physical examination compared to men 5
• MRI has higher sensitivity and specificity than ultrasonography and should be used for diagnosing occult hernias if clinical suspicion remains high despite negative ultrasound findings 5
• Always examine both groins bilaterally, as contralateral patent processus vaginalis occurs in 64% of infants younger than 2 months 3

Management Imperatives

Surgical Timing

• Watchful waiting is NOT recommended in females with inguinal hernias due to the higher emergency surgery rates and increased risk of femoral hernia complications 5, 1
• All inguinal hernias in female infants require urgent surgical referral for repair within 1-2 weeks of diagnosis to prevent life-threatening complications 3
• Hernias during pregnancy should not be operated on 1

Surgical Technique Considerations

• During surgical repair in females, the presence of a femoral hernia should always be excluded, and if detected, should be repaired using a laparo-endoscopic or open preperitoneal mesh technique 1
• At reoperation in females, 41.5% have a femoral hernia found (compared to only 5.4% in males), suggesting the need for femoral canal exploration at the primary operation 6
• Laparoscopic repair (LIHR) is highly recommended for female patients 2

Outcomes and Complications

• Females experience higher reoperation rates (4.3%) compared to males (3.1%) 6
• A higher rate of chronic postoperative inguinal pain must be expected in females 1
• Females undergoing inguinal hernia repair have more preoperative risk factors than males, including higher rates of constipation, GERD, and asthma 7

Critical Pitfall to Avoid

The most dangerous error is failing to examine for and exclude femoral hernias in females, as these have substantially higher strangulation risk and account for a large proportion of emergency presentations and reoperations 1, 6