What is the likely cause of sharp pains and spasms in the right groin of a 40-year-old male, presenting 2 days after intercourse, with no obvious triggers, urinary symptoms, or ejaculatory symptoms, and a self-diagnosed suspicion of a pulled muscle?

Acute Groin Muscle Strain (Adductor-Related Groin Pain)

This presentation is most consistent with an acute adductor muscle strain, and initial management should include rest, NSAIDs, and active supervised physical therapy once the acute pain subsides.

Clinical Reasoning

The clinical picture strongly suggests a musculoskeletal injury rather than a urological emergency:

• Sharp pain and spasms localized to the right groin occurring after intercourse points to mechanical muscle strain 1, 2
• Absence of urinary symptoms makes epididymitis, urinary tract pathology, and renal colic unlikely 3
• Absence of ejaculatory symptoms makes chronic prostatitis/chronic pelvic pain syndrome less likely 4, 5
• No penile swelling, ecchymosis, or detumescence rules out penile fracture 6
• No rigid erection excludes priapism 4, 6
• The temporal relationship to intercourse and patient's self-assessment of "pulling something" aligns with adductor muscle overload during hip abduction/flexion movements 1, 2

Key Physical Examination Findings to Confirm

• Adductor squeeze test: Have the patient lie supine with hips abducted and flexed at 80 degrees; sharp groin pain when attempting to pull legs together against resistance confirms adductor-related groin pain 1
• Direct palpation over the adductor longus tendon insertion at the pubic tubercle should reproduce the pain 2
• Absence of testicular tenderness, swelling, or masses on genital examination helps exclude testicular pathology 3
• Normal cremasteric reflex and testicular lie excludes testicular torsion 6

Initial Management Approach

Conservative treatment is appropriate for adductor-related groin pain 2:

• NSAIDs and muscle relaxants for pain control during the acute phase 1
• Rest from aggravating activities including sexual intercourse until pain resolves 1
• Active, supervised physical therapy should begin once acute pain subsides, focusing on stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas, quadriceps, and hamstrings 1, 2

When to Pursue Advanced Imaging

MRI of the pelvis should be performed if 2:

• The diagnosis remains unclear after physical examination
• Symptoms have not improved after 2-4 weeks of initial conservative management
• There is concern for more severe injury (complete tendon rupture or avulsion fracture)

Red Flags Requiring Urgent Evaluation

Immediate urological consultation is needed if any of the following develop 6, 3:

• Sudden penile swelling with ecchymosis and detumescence (penile fracture)
• Painful rigid erection lasting >4 hours (ischemic priapism)
• Blood at urethral meatus or inability to void (urethral injury)
• Acute testicular pain with swelling (testicular torsion or epididymitis)
• Severe unilateral flank pain radiating to groin (renal colic)

Common Pitfalls to Avoid

• Do not assume all post-coital groin pain is muscular without performing a focused genitourinary examination to exclude emergencies 6, 3
• Do not delay imaging beyond 2-4 weeks if conservative management fails, as chronic adductor tendinopathy may develop 2
• Do not restrict the patient from all activity; gradual return to movement with physical therapy is superior to complete rest 1, 2