How are inguinal and femoral hernias treated in women?

Photo of a woman

The treatment of inguinal hernias is sometimes different in women than in men. Doctors usually recommend surgery. This is because women who have an inguinal hernia are more likely to have a "hidden" femoral hernia too, which is more likely to cause complications.

Inguinal hernias often don't cause any severe symptoms. Femoral hernias, on the other hand, can cause more problems because they are more likely to "pinch" a part of the bowel. Both of these groin hernias can be effectively treated with laparoscopic surgery with the use of a mesh. Laparoscopic surgery is also known as "minimally invasive" or "keyhole" surgery.

What causes inguinal and femoral hernias?

Inguinal hernias can occur if there's a weak point in the inguinal canal in the front abdominal wall. This canal runs diagonally from the hip bone down to the pubic bone, connecting the abdomen with the groin area. It contains nerves, blood vessels and lymphatic vessels. In women, it also contains the round ligament that supports the uterus (womb). Inguinal hernias occur when part of the peritoneum, bowel, or fat tissue bulges through this gap in the abdominal wall. The peritoneum is the membrane that lines the abdominal cavity and (completely or partly) encloses most of the organs in the abdomen.

Inguinal hernias are much less common in women because their inguinal canal is narrower. But weak connective tissue can increase the likelihood of having an inguinal hernia. The risk also increases with age. Lifting or carrying heavy objects probably doesn't affect the risk, or only plays a small role at the most.

Femoral hernias occur in the upper part of the thigh, just below the inguinal ligament. They are most common in women over the age of 65. Because they don't cause a visible bump, they are often not noticeable at first. The first sign is usually pain instead. Femoral hernias are sometimes confused with inguinal hernias, but are more painful.

Illustration: Inguinal and femoral hernia in women

When is surgery considered?

Unlike men, women are advised to have surgery for symptom-free inguinal hernias too because their risk of complications is higher. Also, women who have an inguinal hernia are more likely to have a “hidden” femoral hernia as well. This can often only be determined by doctors during surgery.

Femoral hernias are associated with a high risk of complications if surgery isn’t performed. Part of the bowel could become “trapped” in the gap in the abdominal wall, and that could lead to a blocked bowel (obstruction) or an of the peritoneum (peritonitis). About half of all women who have a hidden femoral hernia end up needing emergency surgery later.

What are the side effects of surgery?

Hernia operations are among the most commonly performed surgical procedures in Germany. Although complications are rare, side effects are possible. And anesthetics are always associated with risks.

Pain resulting from surgery in the groin area usually goes away within a few days. But about 10 out of 100 people have long-term pain following the surgery. The pain may be caused by nerve damage or reactions to the synthetic mesh. This kind of long-term pain is more common in women than in men.

Fewer than 1 out of 100 people have more serious complications after surgery. These include damage to blood vessels or the nerves inside the inguinal canal. Wound-healing problems and inflammations may occur too.

What are the different types of surgery?

During surgery, the hernia sac is moved back into the abdomen together with its contents. The gap in the abdominal wall is then closed off. It can also be reinforced with tissue from another part of the body or with a fine synthetic mesh.

There are three main types of surgery:

  • Open surgery without mesh: Surgery is performed from outside the body through quite a long cut, and the gap is sewn together with neighboring connective tissue.
  • Open surgery with mesh: The area where the gap used to be is covered with a synthetic mesh to strengthen the abdominal wall.
  • Minimally invasive surgery (also known as keyhole or laparoscopic surgery): Three small incisions are usually made in the skin (5 to 10 millimeters long). A camera and surgical instruments can then be inserted into the abdomen or as far as the abdominal wall through these cuts. In minimally invasive surgery, the area where the opening of the hernia used to be is always covered with synthetic mesh.

Which types of surgery are most suitable?

Because women are much more likely to have develop another hernia after open surgery, inguinal and femoral hernias are usually treated with minimally invasive surgery. Adding a synthetic mesh strengthens the abdominal wall somewhat better than only closing the gap by sewing it on to neighboring connective tissue. This also makes it possible to return to normal activities sooner after the surgery.

There are two main types of minimally invasive surgery:

  • TAPP (transabdominal preperitoneal): The surgery is performed via the abdomen. To do so, small cuts have to be made in the abdominal wall.
  • TEP (totally extraperitoneal): Surgery is performed on the abdominal wall only. This means that the surgical instruments aren't inserted as deeply as they are in TAPP.

Studies don’t show any differences between TAPP and TEP. Pain, side effects and recurrence of hernias are equally common, and it takes about the same amount of time to get back to work after both kinds of surgery.

What do I need to know after having surgery?

You can return to physical activity very soon after having hernia surgery with the use of mesh. Walking and gentle physiotherapy exercises are already possible just a few hours later. The type and intensity of exercise should be chosen based on how you feel and how you are coping with the exertion. It is better to avoid lifting heavy objects in the first 2 to 3 weeks.

What can you do if the hernia comes back?

The risk of developing another hernia varies from person to person, but it is greater in women than it is in men. Because of this, doctors generally recommend already using mesh the first time the hernia is operated on. If another hernia develops, the recommended treatment is minimally invasive surgery using mesh again.

What if you develop a hernia during pregnancy?

It is very rare for inguinal or femoral hernias to occur during pregnancy. But if they do, doctors recommend waiting and having the hernia surgery after the pregnancy. Urgent surgery is only needed if the hernia pinches something and there's a risk of complications. But this very rarely happens in pregnant women. The hernia won't affect the pregnancy.

Berger D. Evidenzbasierte Behandlung der Leistenhernie des Erwachsenen [Evidence-Based Hernia Treatment in Adults]. Dtsch Arztebl Int 2016; 113(9): 150-158.

Fitzgibbons RJ, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med 2015; 372(8): 756-763.

HerniaSurge Group. International guidelines for groin hernia management. Hernia 2018; 22(1): 1-165.

Köckerling F, Koch A, Lorenz R. Groin Hernias in Women – A Review of the Literature. Front Surg 2019; 6: 4.

Lockhart K, Dunn D, Teo S et al. Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev 2018; (9): CD011517.

Mathes T, Prediger B, Walgenbach M et al. Mesh fixation techniques in primary ventral or incisional hernia repair. Cochrane Database Syst Rev 2021; (5): CD011563.

Svendsen SW, Frost P, Vad MV et al. Risk and prognosis of inguinal hernia in relation to occupational mechanical exposures – a systematic review of the epidemiologic evidence. Scand J Work Environ Health 2013; 39(1): 5-26.

Treadwell J, Tipton K, Oyesanmi O et al. Surgical options for inguinal hernia: comparative effectiveness review (AHRQ Comparative Effectiveness Reviews; No. 70). 2012.

Wei FX, Zhang YC, Han W et al. Transabdominal Preperitoneal (TAPP) Versus Totally Extraperitoneal (TEP) for Laparoscopic Hernia Repair: A Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2015; 25(5): 375-383.

Whalen HR, Kidd GA, O'Dwyer PJ. Femoral hernias. BMJ 2011; 343: d7668.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on December 13, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.