Evaluation of acute pelvic pain in the adolescent female
- Kathleen Brown, MD
Kathleen Brown, MD
- Associate Professor of Pediatrics and Emergency Medicine
- The George Washington University School of Medicine
- June A Lee, MD
June A Lee, MD
- Assistant Professor of Pediatrics and Emergency Medicine
- New York Presbyterian-Weill Cornell Medical Center
- Section Editor
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review the differential diagnosis and approach to the adolescent female presenting with pelvic pain with an emphasis on gynecologic conditions. The gastrointestinal and urologic causes of abdominal pain are discussed in greater detail separately. (See "Causes of acute abdominal pain in children and adolescents".)
The evaluation of acute pelvic pain in older women is also discussed separately. (See "Evaluation of acute pelvic pain in women".)
Pelvic pain most often involves the gastrointestinal or the urinary systems in prepubertal girls. However, gynecologic conditions become more prevalent as etiologies for pelvic pain, especially during late adolescence. The gynecologic causes of acute pelvic pain in adolescent females are listed in the table (table 1).
Life-threatening conditions — Complications of pregnancy (eg, ectopic pregnancy, acute abruption, uterine rupture) comprise the most frequent life-threatening gynecologic causes of pelvic pain in adolescent females. Gastrointestinal causes of pelvic pain can be life-threatening if they lead to peritonitis and sepsis. Of these, appendicitis is most common and will be presented here. Other conditions (eg, abscess, bowel obstruction) are reviewed separately. (See "Causes of acute abdominal pain in children and adolescents", section on 'Life-threatening causes'.)
Life-threatening pelvic trauma in female adolescents is usually the result of a high-energy mechanism, such as a fall from a height or motor vehicle crash. Injury patterns and management are similar to the approach in adults and are discussed elsewhere. (See "Pelvic trauma: Initial evaluation and management", section on 'Fracture types' and "Pelvic trauma: Initial evaluation and management", section on 'Initial management'.)
- Berkowitz CD. Medical consequences of child sexual abuse. Child Abuse Negl 1998; 22:541.
- Kamm MA. Chronic pelvic pain in women--gastroenterological, gynaecological or psychological? Int J Colorectal Dis 1997; 12:57.
- Kruszka PS, Kruszka SJ. Evaluation of acute pelvic pain in women. Am Fam Physician 2010; 82:141.
- Hewitt GD, Brown RT. Acute and chronic pelvic pain in female adolescents. Med Clin North Am 2000; 84:1009.
- Guttmacher Institute. State policies in brief: An overview of minors' consent law. July 1, 2015. www.guttmacher.org/sections/adolescents.php. (Accessed on July 28, 2015).
- Braverman PK, Breech L, Committee on Adolescence. American Academy of Pediatrics. Clinical report--gynecologic examination for adolescents in the pediatric office setting. Pediatrics 2010; 126:583.
- Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep 2014; 63:1.
- Paltiel HJ, Phelps A. US of the pediatric female pelvis. Radiology 2014; 270:644.
- DIFFERENTIAL DIAGNOSIS
- Life-threatening conditions
- - Ectopic pregnancy
- - Placental abruption
- - Uterine rupture
- - Appendicitis
- - Ovarian torsion
- Common conditions
- - Dysmenorrhea
- - Mittelschmerz
- - Pelvic inflammatory disease
- - Ruptured ovarian cyst
- - Nephrolithiasis
- - Urinary tract infection
- Other gynecologic conditions
- Physical examination
- ALGORITHMIC APPROACH
- - Vaginal bleeding
- - No vaginal bleeding
- Not pregnant
- - Premenarchal
- - Postmenarchal