Pelvic inflammatory disease (PID) is commonly related to sexual intercourse in postpubescent females. Inflammation of the fallopian tubes (pyosalpinx) is a common complication. We describe a case of anatomic spinning top-shaped urethra that led lead to complicated recurrent severe abdominal infections in an 11year-old precoital female. This case highlights that prepubescent females can have pyosalpinx and pelvic inflammatory disease and anatomic contributions to these presentations should be considered.