Question explored with the scientific record
Can adductor muscle problems pull on the front of the pubic bone cause genital pain in women?
The short version: the evidence you have is almost entirely about groin pain in athletes, not about genital pain in women, and the mechanism you ask about is plausible but unstudied in this specific form.
The evidence you retrieved is mostly about adductor strains in male hockey players [1, 2], groin pain diagnostics in athletes [8], and obturator nerve entrapment causing groin pain [11]. None of these studies test whether adductor pathology at the pubic bone causes genital pain in women. The closest match is the 2008 systematic review on long-standing groin pain in athletes [8], which found that adductor-related tenderness at the pubic symphysis is common, but it did not report genital pain as an outcome and studied mostly male soccer and Australian football players. The obturator nerve studies [11, 12] show that nerve entrapment in the adductor region can produce groin and thigh pain, and the obturator nerve does supply sensory branches to the medial thigh and genital area, so a mechanical link is anatomically plausible. But no study in this set measured genital pain specifically in women with adductor pathology.
The chronic pelvic pain literature you have [19, 20, 23, 24] covers endometriosis, interstitial cystitis, and other gynecologic causes, but does not mention adductor muscles as a source. One review [20] notes that about one third of women with chronic pelvic pain have no organic cause found at laparoscopy, leaving room for musculoskeletal contributors, but that is an absence of evidence, not evidence for the adductor hypothesis.
The mechanism is sound in principle. The hip adductors originate on the pubic bone. Chronic tension, trigger points, or enthesopathy at that attachment can refer pain along the nerve pathways that supply the area, including the genital branch of the genitofemoral nerve and the obturator nerve. This is well documented for groin pain in athletes [8, 11] and for pelvic floor dysfunction more broadly, but the specific question of adductor-to-genital pain in women has not been tested in any study you provided.
My call: the hypothesis is anatomically plausible and consistent with known patterns of referred pain from the adductor compartment, but the evidence you have does not confirm it for women with genital pain. A clinician should consider it as a differential, especially when gynecologic workup is negative, but the burden of proof has not been met. Confidence: low, because the question was never studied in the population you asked about.
Sources used 9
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The Effectiveness of a Preseason Exercise Program to Prevent Adductor Muscle Strains in Professional Ice Hockey Players
This study evaluates the effectiveness of a preseason exercise program aimed at strengthening hip adductor muscles to reduce the incidence of adductor muscle strains in professional ice hockey players, demonstrating a significant reduction in strain occurrences post-intervention.
DOI: 10.1177/03635465020300050801 -
Hip adductor muscle function in forward skating
This study investigates the relationship between skating speed, muscle activity, and lower limb kinematics in collegiate ice hockey players, highlighting the significant role of the hip adductors in skating performance and the potential for groin strain injuries at higher speeds.
DOI: 10.1080/14763140903229534 -
Diagnostics in athletes with long‐standing groin pain
A systematic review evaluating the diagnostic tests, imaging modalities, and etiological factors for long-standing groin pain in athletes, concluding that MRI/ultrasound are useful after clinical assessment while adductor/pelvis tests have variable validity and subgroups exist w…
DOI: 10.1111/j.1600-0838.2008.00848.x -
Obturator Nerve Entrapment
A prospective study of 32 athletes with chronic groin pain due to obturator neuropathy, detailing clinical features, diagnostic EMG/bone scans and fluoroscopic nerve blocks, and demonstrating favorable outcomes after obturator nerve neurolysis with most athletes returning to spo…
DOI: 10.1177/036354659702500322 -
Ultrasound-Guided Obturator Nerve Block: A Sonoanatomic Study of a New Methodologic Approach
This study presents a novel ultrasound-guided approach for obturator nerve block, detailing its anatomical localization in cadavers and volunteers, and demonstrating its clinical applicability in patients with chronic pain.
DOI: 10.1213/ane.0b013e3181966f03 -
Chronic pelvic pain in women
This review discusses chronic pelvic pain (CPP) in women, its prevalence, associated factors, and the importance of a multidisciplinary approach to diagnosis and treatment.
DOI: 10.1136/pgmj.2008.073494 -
Chronic pelvic pain in women
This BMJ clinical review synthesizes current knowledge on chronic pelvic pain in women, detailing its epidemiology, diagnostic challenges (including the limited diagnostic yield of laparoscopy versus MRI in some cases), and the value of multidisciplinary management supported by …
DOI: 10.1136/bmj.c4834 -
Interstitial Cystitis Is an Etiology of Chronic Pelvic Pain in Young Women
This study investigates the prevalence of interstitial cystitis (IC) as a cause of chronic pelvic pain (CPP) in young women, finding that IC is diagnosed in 39% of the cases studied, with urinary frequency and dyspareunia being significant predictors of the diagnosis.
DOI: 10.1016/j.jpag.2008.04.008 -
Endometriosis
This study highlights the challenges in diagnosing endometriosis, a common yet often overlooked condition affecting women, emphasizing the need for better recognition and management strategies in primary care.
DOI: 10.1136/bmj.c2168