Can a femoral hernia cause scrotal pain in male patients?

Can a Femoral Hernia Cause Scrotal Pain?

Yes, a femoral hernia can cause scrotal pain in male patients, though this is an uncommon presentation that typically occurs through vascular compression of testicular blood supply or direct extension of hernia contents into the scrotum.

Mechanism of Scrotal Pain from Femoral Hernia

• Vascular compression is the primary mechanism by which femoral hernias cause testicular pain, as large hernias can compress the spermatic cord vasculature, leading to testicular ischemia 1.
• A documented case demonstrated that a large indirect inguinal hernia (anatomically adjacent to femoral hernias) caused acute testicular ischemia through vascular compression, with immediate symptom relief and restoration of testicular blood flow after hernia reduction 1.
• Direct extension into the scrotum can occur, as femoral hernias may contain bowel or other structures that extend inferiorly, causing scrotal swelling and pain 2.

Critical Diagnostic Considerations

• Testicular torsion must be excluded first in any patient presenting with acute scrotal pain, as surgical intervention within 6-8 hours is essential to prevent testicular loss 3.
• Duplex Doppler ultrasound should be performed urgently, with sensitivity of 69-96.8% and specificity of 87-100% for detecting compromised testicular blood flow 3.
• Key ultrasound findings to differentiate causes include:
  • Decreased or absent testicular blood flow suggests vascular compromise from hernia compression or torsion 3, 1
  • Whirlpool sign indicates testicular torsion specifically 3
  • Visualization of hernia contents extending toward or into the scrotum 2

Clinical Presentation Patterns

• Acute presentation: Sudden onset of severe testicular pain with a known or newly discovered femoral hernia suggests vascular compromise requiring emergency intervention 1.
• Chronic/recurrent presentation: Periodic groin and scrotal discomfort may occur with reducible femoral hernias, though this is less common 4.
• Femoral hernias are more common in adult women (female to male ratio 8:1), making this presentation rare in males 5.

Management Algorithm

• Immediate reduction should be attempted if a large femoral hernia is identified with acute testicular pain and compromised blood flow on ultrasound 1.
• Manual reduction with the patient supine may restore testicular perfusion within 15 minutes, with repeat ultrasound to confirm flow restoration 1.
• Urgent surgical consultation (both urology and general surgery) is mandatory when testicular ischemia is suspected from any cause 3, 1.
• If reduction fails or testicular viability remains questionable, emergency surgical exploration is required within 6-8 hours 3.

Important Clinical Pitfalls

• Do not assume all scrotal pain with a hernia is benign—vascular compromise can occur and requires the same urgency as testicular torsion 1.
• Femoral hernias have higher incarceration rates than other groin hernias, increasing the risk of complications including vascular compression 5.
• False-negative Doppler studies occur in up to 30% of cases with partial vascular compromise, so high clinical suspicion should prompt surgical exploration regardless of imaging 3.
• Prior groin surgery or vascular grafts (present in 33.9% of femoral hernia patients) can complicate both diagnosis and surgical repair 2, 5.