05/27/2026
Six major randomized controlled trials have studied a procedure that kills women at 5%. Across all six trials, seven women were enrolled. Most enrolled zero.
Shirin Towfigh, MD is a surgeon and hernia specialist.
The procedure is a femoral hernia repair. Women are 10 times more likely than men to have femoral hernias, and a femoral hernia that ruptures carries the highest mortality of any hernia we treat. The research foundation behind how we manage these women is six trials and seven women.
So when a young woman shows up in a primary care office with chronic pelvic pain, the system does what it was built to do. It sends her to the gynecologist. They treat her for endometriosis. Then ovarian cysts. Then vulvodynia. Two years go by. She is more likely to be on narcotics preoperatively than the men in the same situation. And at some point, after every other diagnosis has failed her, she is told it might be in her head.
Then a surgeon palpates her inguinal canal and finds the hernia that has been there the whole time. Younger and thinner women do not present with a bulge. They present with pain, urinary frequency, pain during in*******se, pain during me**es. The imaging that would have shown it two years ago was never ordered.
This is not a story about one bad clinic. It is a story about what happens when half the patient population is left out of the trials that build the standard of care. The pelvic pain workup that does not include hernia is not a clinical preference. It is a downstream consequence of a research design that never bothered to look.
Towfigh put it this way:
"Most studies on hernia care have had zero women."
Listen to the full conversation on The Podcast by KevinMD. Link in the comments.
