Causes of Pain Over the Pubic Tubercle

Primary Musculoskeletal Causes

Insufficiency or fatigue fractures of the pubic rami can cause localized pain over the pubic tubercle, with MRI without contrast being the most sensitive imaging modality for detecting occult pelvic stress fractures when radiographs are negative 1

Genitourinary tuberculosis can affect the pelvis and present with non-specific symptoms including abdominal pain, though this is rare in non-endemic regions 2
Epididymitis is characterized by pain, swelling, and elevated temperature of the epididymis, with pain that can radiate to the lower abdomen and pubic region, and in up to 90% of cases, pathogens migrate from the urethra or bladder, with predominant organisms being Enterobacterales, Chlamydia trachomatis, and Neisseria gonorrhoeae 2
Fournier's Gangrene is an aggressive polymicrobial soft-tissue infection of the perineum and external genitalia that can present with painful swelling that may extend to the pubic region, and in up to 40% of cases, onset is insidious with undiagnosed pain, requiring high clinical suspicion 2

Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is characterized by pain (including pressure and discomfort) related to bladder filling, with typical patients reporting suprapubic pain, and pain extends throughout the pelvis including the urethra 3
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is characterized by pain in the perineum, suprapubic region, testicles, or tip of the penis, often exacerbated by urination or ejaculation, and the diagnosis of IC/BPS should be strongly considered in men whose pain is perceived to be related to the bladder 3
Pelvic Inflammatory Disease (PID) can cause lower abdominal and suprapubic pain with uterine/adnexal tenderness or cervical motion tenderness, and empiric treatment should be initiated in sexually active young women with minimum criteria present and no other identifiable cause 4

The American College of Radiology recommends ultrasound with Doppler as the initial imaging study of choice for pelvic congestion syndrome, showing engorged veins ≥8 mm with low-velocity and retrograde flow, however this fact is from Praxis Medical Insights and will be replaced with a fact from Journal of the American College of Radiology: Strangulated inguinal hernia can present as acute scrotal and lower abdominal pain extending to the pubic region 5

Transvaginal ultrasound combined with transabdominal approach is the initial imaging study of choice for evaluating postmenopausal subacute or chronic pelvic pain, according to the Journal of the American College of Radiology 8

For suspected osteitis pubis, the Journal of the American College of Radiology recommends considering MRI for early diagnosis or when radiographs are negative 1
For suspected infectious etiology, European Urology recommends obtaining appropriate cultures and considering imaging (CT or MRI) to differentiate osteomyelitis from osteitis pubis 2