View source for Prepubertal pelvic pain

{{PediatricPage|Pelvic pain}}
==Background==
[[File:Blausen 0732 PID-Sites.png|thumb|Pelvic anatomy.]]
*Pelvic pain in prepubertal children has a different differential than in post-pubertal/adult patients
*Pregnancy-related causes are not applicable (but always consider the possibility of sexual abuse)
*Most common causes: [[UTI]], [[constipation]], [[appendicitis]]
*Key EM concerns: [[ovarian torsion]] (can occur at any age), [[appendicitis]], sexual abuse, incarcerated hernia

==Clinical Features==
===History===
*Onset, location, duration, character
*Urinary symptoms (UTI)
*Bowel habits (constipation is a very common cause)
*Vaginal discharge or bleeding (foreign body, vulvovaginitis, abuse)
*Fever (UTI, appendicitis, abscess)
*Vomiting (appendicitis, ovarian torsion)
*Any concern for abuse — screen carefully

===Physical Exam===
*Abdominal exam: tenderness, guarding, peritoneal signs
*External genital exam: discharge, bleeding, irritation, foreign body, signs of trauma
*Internal/speculum exam is generally NOT indicated in prepubertal children
*Rectal exam if necessary (appendicitis)

===Red Flags===
*Severe acute unilateral pain (ovarian torsion)
*Peritoneal signs (appendicitis, perforated viscus)
*Vaginal bleeding in prepubertal child (foreign body, abuse, precocious puberty, tumor)
*Signs of sexual abuse (genital trauma, STI symptoms, behavioral changes)

==Differential Diagnosis==
{{Prepubertal pelvic pain DDX}}

===GI===
*[[Constipation]] (most common benign cause)
*[[Appendicitis]]
*Mesenteric lymphadenitis
*[[Intussusception]]
*Meckel diverticulum

===GU===
*[[UTI]]
*[[Ovarian torsion]] (can occur even without ovarian mass)
*Ovarian cyst (functional — rare prepubertally but can occur)
*Labial adhesions (can cause urinary retention)

===Gynecologic===
*Vaginal foreign body
*Vulvovaginitis (nonspecific irritation, poor hygiene)

===Other===
*Inguinal hernia (incarcerated)
*Musculoskeletal (hip pathology, muscle strain)
*Abuse — always consider

==Evaluation==
*[[Urinalysis]] + culture
*Abdominal X-ray if constipation suspected (to confirm or rule out fecal loading)
*Pelvic/abdominal ultrasound if ovarian torsion, mass, or appendicitis suspected
*CT abdomen/pelvis if appendicitis high on differential and US nondiagnostic
*STI testing if concern for abuse

==Management==
*Constipation: enema/disimpaction, stool softeners, dietary counseling
*UTI: age-appropriate antibiotics (see [[UTI (peds)]])
*Appendicitis: surgical consultation
*Ovarian torsion: emergent surgical consultation for detorsion
*Vaginal foreign body: removal (may require sedation)
*Suspected abuse: child protective services notification, forensic exam per local protocol

==Disposition==
*Admit: appendicitis, ovarian torsion, incarcerated hernia, severe infection
*Discharge: constipation, UTI with ability to take oral antibiotics, resolved pain
*Return precautions: worsening pain, fever, vomiting, vaginal bleeding

==See Also==
*[[Pelvic Pain]]
*[[Abdominal pain (peds)]]
*[[Ovarian torsion]]
*[[UTI (peds)]]
*[[Non-accidental trauma]]

==References==
<references/>

[[Category:Pediatrics]]
[[Category:OBGYN]]
[[Category:Symptoms]]