Evaluation and surgical approaches to gynecologic pelvic pain in pediatric patients

Pelvic pain is a common concern among adolescent females, with gynecologic etiologies ranging from dysmenorrhea, most often due to endometriosis, to obstructive anomalies and adnexal masses. Evaluation requires a detailed history, including menstrual and pain characteristics, functional impact, and relevant family history, as well as a focused physical exam tailored to the adolescent's developmental stage and comfort. Pelvic ultrasonography is often the initial imaging modality, with additional imaging and laboratory testing as adjuncts. Endometriosis, the leading cause of secondary dysmenorrhea, frequently presents with debilitating pain and may require diagnostic laparoscopy if pain persists despite medical therapy. Given the variation in practice patterns and the involvement of multiple specialties, coordinated, evidence-based care is essential. This review outlines the evaluation and surgical management of gynecologic pelvic pain in the pediatric and adolescent population, with a focus on endometriosis.