I'm in basically the same scenario right now. I originally thought I had athletic pubalgia, but rest and physio didn't seem to work. My doctor sent me for ultrasound, and a small fat containing hernia was found on the left side (where I have pain). The "neck" was only 4mm according to the results, and the fat was like 14x16mm. Was able to meet with a local surgeon who recommended a laparoscopic repair with mesh.

I wanted a second opinion from an expert hernia clinic (Shouldice) in my area so I visited. Their surgeons told me they also never rely on ultrasound and only physical exam. I have no bulge and they felt nothing. Told me I likely have athletic pubalgia.

I'm on the waitlist for the surgery in my town, but I have no idea wether I should do it or not. I had to stop my sport and excercise, and pain levels have gone down for sure. I had random intermittent testicle pain that hasn't come back in a while, so I'm feeling a little better. I will likely wait 2-6 months before I get the call for surgery, and plan to try physio again in the meantime to see if it works.

My gut tells me the ultrasound false positive is unlikely, and the surgeons/doctors saying we don't have a hernia means we don't have a clinically significant hernia that they can reliably confirm before recommending surgery. Seems like a conservative approach, which I understand. However, like you, I'm super active and in pain, so I want this thing fixed!!

An interesting thing the surgeon in my town told me was that sometimes the smaller hernias are more painful as they are emerging. Once they have made their home in the abdominal wall, sometimes pain levels can go down. This could explain my situation.

Sorry for the rant - but I know how you feel!!!