Most Common Hernia Type in Females
Femoral hernias represent a disproportionately higher percentage of groin hernias in women (16.7-37% of all groin hernias in females) compared to men, making them the most clinically significant hernia type to consider in female patients, though inguinal hernias remain the most common overall hernia type in both sexes. 1
Key Epidemiological Facts
- The lifetime risk of developing a groin hernia in women is 3-5.8%, substantially lower than in men 1
- Women represent only 8.0-11.5% of all operated groin hernias 1
- Among women who develop groin hernias, femoral hernias account for 16.7-37% of cases—a much higher proportion than in men 1
- The female anatomy has a stronger posterior wall of the inguinal canal due to the gubernaculum persisting as the ovarian round ligament, which provides some protection against inguinal herniation 2
Critical Clinical Implications
Emergency Presentation Risk
Women with groin hernias face a 3-4 fold higher rate of emergency procedures (14.5-17.0%) compared to men, with femoral hernias specifically having a 40.6% emergency rate. 1 This dramatically elevated risk of incarceration and strangulation means:
- Watchful waiting is NOT indicated in women with groin hernias 1
- Any detected groin hernia in a female patient should be referred for surgical repair 1
- The higher emergency rate reflects delayed diagnosis and the anatomically narrower femoral canal predisposing to incarceration 1
Surgical Approach Considerations
During any groin hernia repair in females, the presence of a femoral hernia must always be excluded and if detected should be repaired using a laparo-endoscopic or open preperitoneal mesh technique. 1 This is critical because:
- Femoral hernias can be missed on initial examination 1
- The anatomical relationship between the inguinal and femoral canals requires systematic evaluation of both 1
Other Important Hernia Types in Females
Pelvic Floor Hernias
Women uniquely experience pelvic organ prolapse and associated hernias including 3:
- Cystocele and urethrocele (anterior compartment)
- Uterine/cervical and vaginal prolapse (apical compartment)
- Rectocele (posterior compartment)
- Peritoneocele, enterocele, and sigmoidocele (cul-de-sac hernias)
Perineal Hernias
Perineal hernias are more common in females due to the broader female pelvis and attenuation of the pelvic floor during pregnancy and childbirth 4
Risk Factors Specific to Women
- High age 1
- Positive family history 1
- Pregnancy and childbirth (for perineal and pelvic floor hernias) 4
Common Pitfalls to Avoid
- Failing to examine for femoral hernias when evaluating any groin mass in women—the higher proportion of femoral hernias in females makes this examination mandatory 1
- Adopting a watchful waiting approach—the substantially higher emergency rate in women makes this dangerous 1
- Assuming all groin hernias are inguinal—the 16.7-37% femoral hernia rate in women requires systematic evaluation 1
- Expecting lower chronic pain rates—women actually experience higher rates of chronic postoperative inguinal pain after repair 1