Case of a Girl with Chronic Abdominal Pain, Frequent Emergency Room Visits, and Opioid Abuse
A 17-year-old G1P0010 girl was referred to an adolescent medicine specialist by the emergency department (ED) for evaluation of chronic abdominal pain recurring over the past year after she was seen in the ED 2 days ago for cervicitis. She has a history of physical and sexual abuse, extensive psychiatric history, prescription narcotic abuse, gynecologic history of pelvic inflammatory disease, and repeated sexually transmitted infections. Physical exam is significant for multiple tattoos, linear thigh hematoma, diffuse abdominal tenderness to palpation, scant vaginal discharge, and tearfulness on pelvic exam. She seems agitated and uses her cell phone to text throughout the clinic visit. Presentation is concerning for chronic pelvic pain and possible domestic minor sex trafficking (DMST). Because victims of DMST rarely self-identify, it is critical for physicians to recognize the warning signs of sex trafficking and effectively intervene on behalf of these patients to directly affect recovery and outcomes.
KeywordsChronic pelvic pain (CPP) Human sex trafficking Commercial sexual exploitation of children (CSEC) Domestic minor sex trafficking (DMST)
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