Prepubertal pelvic pain: Difference between revisions

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== Pelvic Pain Prepubertal DDX ==
{{PediatricPage|Pelvic pain}}
==== Gynecologic ====
==Background==
#Trauma
[[File:Blausen 0732 PID-Sites.png|thumb|Pelvic anatomy.]]
##Laceration
*Pelvic pain in prepubertal children has a different differential than in post-pubertal/adult patients
##Hematoma
*Pregnancy-related causes are not applicable (but always consider the possibility of sexual abuse)
##Sexual Abuse
*Most common causes: [[UTI]], [[constipation]], [[appendicitis]]
#Vaginal foreign body
*Key EM concerns: [[ovarian torsion]] (can occur at any age), [[appendicitis]], sexual abuse, incarcerated hernia
#Vaginal infection
##[[Candida Vaginitis]]
#[[Contact Vulvovaginitis]]
##Chemicals (bubble baths)
##Poor hygiene
##Allergic dermatitis
##Parasitic infestation (pinworms)
#Outflow-tract obstruction
##Imperforate hymen
##Labial adhesions
##Congenital abnormalities


==== Gastrointestinal ====
==Clinical Features==
#Appendicitis
===History===
#Gastroenteritis
*Onset, location, duration, character
#Obstruction
*Urinary symptoms (UTI)
#Constipation
*Bowel habits (constipation is a very common cause)
#Volvulus
*Vaginal discharge or bleeding (foreign body, vulvovaginitis, abuse)
==== Musculoskeletal ====
*Fever (UTI, appendicitis, abscess)
#Muscle tendon injury
*Vomiting (appendicitis, ovarian torsion)
#Growth-plate injury
*Any concern for abuse — screen carefully
#Ligamentous injury
#Avulsion fracture
#Inguinal hernia
#Intervertebral disc herniation
==== Urologic ====
#Nephrolithiasis
#Cystitis
#Pyelonephritis
#Urethritis


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


== Source ==
===Red Flags===
Hardwood-Nuss
*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)


== See Also ==
==Differential Diagnosis==
[[Pelvic Pain]]
{{Prepubertal pelvic pain DDX}}


[[Category:Peds]]
===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]]

Latest revision as of 09:32, 22 March 2026

This page is for pediatric patients. For adult patients, see: Pelvic pain

Background

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

Gynecologic

Gastrointestinal

Musculoskeletal

  • Muscle tendon injury
  • Growth-plate injury
  • Ligamentous injury
  • Avulsion fracture
  • Inguinal hernia
  • Intervertebral disc herniation

Urologic

Other

GI

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

References

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