Pediatric and Adolescent Pelvic Masses

What are pelvic masses?

A pelvic mass is extra tissue that grows in the pelvis (lower belly). The pelvic area holds the intestines, bladder and ureters (tubes that connect the bladder to the kidneys). The reproductive organs are also in the pelvic area.

In females, these organs include the:

• Ovaries: A pair of organs that produce eggs

• Fallopian tubes: Tubes that connect the ovaries to the uterus

• Uterus: Organ where babies grow

• Cervix: End of the uterus that connects to the vagina (birth canal)

Pelvic masses are rare in infants and young children. They’re more common in teenage girls who have started to menstruate (have periods).

What are the different types of pelvic masses in children?

The types of pelvic masses that typically develop in children and teen girls include:

Adnexal cysts

Cysts are sacs that can contain fluid, blood or tissue. Adnexal cysts grow inside the ovaries or fallopian tubes. They can also grow in connective tissues around the uterus.

Ovarian cysts

Ovarian cysts can form in or on the ovaries. They can occur in one or both ovaries. Ovarian cysts usually aren’t cancerous, but certain types can lead to cancer. In teens who menstruate (have periods), ovarian cysts can come in the form of endometriomas. These cysts contain old menstrual (period) blood. Endometriomas can be a sign of a more serious condition, endometriosis, which can lead to infertility later in life.

Uterine masses

In rare cases, masses can also form in the uterus. Sometimes they are cysts filled with old menstrual blood, like endometriomas. Sometimes they are extra tissue that grew when the uterus was formed. Less often, they are bundles of muscle or connective tissue called uterine fibroids.

What are the signs and symptoms of pelvic masses in children?

Not all pelvic masses cause symptoms. When signs and symptoms do occur, they may include:

• Pain in the pelvis, which might get worse during menstrual periods

• Swelling or bloating in the belly

• Unusual vaginal discharge (fluid from the vagina)

• Frequent urination due to pressure on the bladder

• Nausea and vomiting

• Early puberty, such as breast, underarm hair and pubic hair growth

How are pediatric and adolescent pelvic masses diagnosed?

The signs of pelvic masses in children and teens can look like those in other health conditions. That’s why it’s important for your child to see a pediatric specialist with experience in adolescent gynecology.

Gynecologists and adolescent medicine specialists in our Adolescent and Young Adult Medicine (AYA) and Pediatric and Adolescent Gynecology programs provide care for children and teens. These highly trained doctors have experience in distinguishing the signs of pediatric pelvic masses.

We begin with a complete physical exam, checking the outside of your child’s belly and pelvic area for signs of a pelvic mass. We’ll also ask about their symptoms and family medical history. If your child is old enough, we’ll talk about any menstrual changes.

We usually recommend tests to help us confirm a diagnosis and plan your child’s treatment. Your child might need one or more tests, which include:

• Blood tests and urinalysis : We take small samples of your child’s blood and urine to test for signs of infection. The tests can also show how well the kidneys and bladder are working, in case a pelvic mass is affecting those organs.

• Pelvic ultrasound: An ultrasound uses sound waves to create images of the inside of the body. We use pelvic ultrasound to determine the size, location and type of pelvic mass. This imaging can also show whether a mass is causing ovary or fallopian tube torsion (twisting).

• Magnetic resonance imaging (MRI): An MRI uses radio waves and powerful magnetic fields to create images of the inside of the body. An MRI can provide a more detailed view of a pelvic mass than an ultrasound.

• Gynecology exam: We may do a pelvic exam to see whether a mass is affecting your child’s reproductive organs. Internal pelvic exams are rarely necessary for pelvic masses. When we do them, we take special steps to help the child understand and feel comfortable. Parents or caregivers can be in the room if your child wishes.

What causes pelvic masses in children and teens?

The cause of a pelvic mass depends on its type:

• Adnexal cysts can happen if the ovaries produce too many hormones. They can also result from bleeding during ovulation (the release of an egg from an ovary).

• Endometriomas can result from endometriosis. The exact cause of endometriosis isn’t clear, but it does tend to run in families.

• Ovarian cysts may form as a result of the typical teenage menstrual cycle. Some risk factors for ovarian cysts in teens include endometriosis and polycystic ovary syndrome.

• Uterine cysts may happen when the uterus formed differently before birth. The cysts can grow as your child gets older.

How are pediatric and adolescent pelvic masses treated?

The pediatric specialists in our Adolescent and Young Adult Medicine (AYA) and Pediatric and Adolescent Gynecology programs treat pelvic masses. We work with surgeons in our General and Thoracic Surgery program when children and teens need surgery to remove a pelvic mass.

Our expert team works together to create a treatment plan for your child. We consider your child’s age, overall health, the type of pelvic mass and whether it’s causing symptoms.

Watchful waiting

Pelvic masses that don’t cause symptoms might not need treatment. We’ll monitor your child with regular checkups every few months. During these visits, we’ll do ultrasounds to see whether the mass is growing.

Cyst drainage

We may drain cysts that are filled with fluid and larger than 2 inches (5 cm) across. We insert a long, thin needle into the cyst to draw out the fluid. Draining the cyst shrinks it. We sometimes inject medicine to close the cyst too.

Surgery to remove a pelvic mass

We may recommend removing pelvic masses that grow larger and cause symptoms. Whenever possible, our surgeons use minimally invasive laparoscopic surgery, which uses only a few small cuts (incisions). We insert a scope (thin tube with a camera) and long, narrow instruments through the cuts.

We work carefully to remove pelvic masses while leaving ovaries and other organs intact. We talk through your concerns about surgery and do everything we can to preserve your child’s ability to have kids later in life.

Medications to treat pelvic masses and their symptoms

We may prescribe medications to help manage the symptoms of pelvic masses. Your child might need one or a combination of medications, such as:

• Hormonal contraceptives: Birth control pills, injections, patches or implants can help shrink endometriomas. These medications can also help prevent more ovarian cysts from forming.

• Pain relievers: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pelvic pain. Common NSAIDs include ibuprofen (Advil^®, Motrin^® and others) and naproxen sodium (Aleve^®).