Groin Pain: When to Seek Help and What to Expect

Pubic symphysis pain

Hello Dr.
Chen: I have been experiencing pain near my pubic bone for almost a year.
The location is approximately at the front right side near the edge of my bikini swimwear.
I have already consulted a gynecologist, as the pain seems to be more pronounced during my menstrual period.
However, the doctor said there is no issue with my uterus.
The area I am referring to is primarily muscle tissue, but I still have persistent pain.
Upon careful examination, I found a small nodule that is very painful when touched.
I also researched online and found that there might be lymph nodes near the right side of the pubic bone.
I would like to ask you, Dr.
Chen: (1) I would like to make an appointment with a doctor, but I am unsure which specialty to choose.
Should I see an oncologist, a surgeon, or a gastroenterologist, or perhaps a specialist related to the abdomen? (2) Is there an ultrasound or any other examination that can "visualize" the condition? The gynecologist mentioned that the area consists of muscle and that there isn't much that can be seen with ultrasound...
Are there other instruments available for examination? (3) I am also quite worried, but I found information stating that if it were cancer, it usually wouldn't cause much pain; pain is typically associated with inflammation.
Is this understanding generally correct? I apologize for taking your time with my questions amidst your busy schedule, and thank you very much.

Miss Zhang, 40~49 year old female. Ask Date: 2015/07/02

Dr. Chen Sirong reply Oncology

Ms.
Chang / 42 / 1 Hello, which department should I register for? I still recommend obstetrics and gynecology or general surgery, so that the second physician can take a look at (2) the muscles.
There isn't much ultrasound that can be done...
Are there any other instruments for examination? CT scans and MRIs can be considered, but if the physician does not palpate a distinct tumor, ordering tests indiscriminately may lead to denial by health insurance.
Unless you are very concerned and insist on self-paying for the examination even if the physician does not find anything.
(3) I am also very worried, but research indicates that if it is cancer, it usually does not cause much pain; pain is typically a sign of inflammation.
Is this understanding generally correct? Cancer may not cause pain when it is small, but as it grows and compresses nerves, muscles, or bones, it can indeed cause pain, or it may be accompanied by infection leading to inflammatory pain.
I hope you seek medical attention as soon as possible.
Thank you for your letter.
Dr.
Chen Si-Rong, Taoyuan Hospital.

Reply Date: 2015/07/02

More Info

Hello,
Thank you for reaching out with your concerns about the groin pain you've been experiencing for nearly a year. It’s understandable to feel anxious about persistent pain, especially when it affects your daily life. Let’s address your questions one by one.

1. Which Specialist to See: Given the location and nature of your pain, it would be advisable to consult with a few different specialists. Since you have already seen a gynecologist, you might consider visiting an orthopedic specialist, as they focus on musculoskeletal issues, including muscles, bones, and joints. Additionally, a sports medicine physician could also be helpful, especially if your pain is related to muscle strain or injury. If there is a concern about lymph nodes or any potential tumors, a visit to an oncologist may be warranted, but this should typically follow an evaluation by a primary care physician or orthopedic specialist who can assess whether further investigation is needed.

2. Diagnostic Imaging: While ultrasound is commonly used in gynecological assessments, it may not always provide a clear picture of muscle or soft tissue issues. In your case, a Magnetic Resonance Imaging (MRI) scan would be more appropriate as it offers detailed images of soft tissues, including muscles, tendons, and ligaments. An MRI can help identify any abnormalities such as tears, inflammation, or other conditions that may not be visible on an ultrasound. A CT scan could also be considered if there are concerns about deeper structures or if an MRI is contraindicated.

3. Understanding Pain and Cancer: Your concern about cancer is valid, but it’s important to note that while some cancers may not present with pain, many conditions, including infections and inflammatory processes, can cause significant discomfort. Pain is often associated with inflammation, which can occur in various conditions, including infections, muscle strains, or even benign growths. It’s also true that cancer-related pain can manifest differently depending on the type and stage of the disease. Therefore, while the general notion that cancer is often painless is somewhat accurate, it does not apply universally. Persistent pain, especially when accompanied by other symptoms (like swelling or a palpable lump), should always be evaluated by a healthcare professional.

In summary, I recommend starting with an orthopedic or sports medicine specialist who can evaluate your symptoms and possibly order an MRI to get a clearer picture of what might be causing your pain. If necessary, they can refer you to other specialists based on their findings. It’s crucial to address this issue sooner rather than later, especially since you’ve been experiencing discomfort for an extended period.

Please remember that while online research can provide some insights, it’s essential to rely on professional medical advice tailored to your specific situation. I wish you the best in finding relief and answers to your concerns.

Take care!

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