Factitious renal stone as a sign of internal conflict about sexual intercourse in an adolescent

Conflicts about the onset of sexual intercourse have been reported to cause a variety of symptoms. A 16-year-old black female claimed to have passed a stone in her urine. Investigation of her complaints caused some doubt that an organic cause was involved. Social history showed that she had recently begun to have sexual intercourse despite a religious belief that intercourse before marriage was wrong. After an extensive medical work-up, she was discharged with instructions to bring in another stone if passed. A stone subsequently presented by the patient proved to be a piece of lead shot. Those caring for adolescents need to be aware that conflicts about sexual intercourse may present in a number of ways, including urinary-tract complaints.