Adnexal masses are common in adolescents. Certain conditions will require immediate intervention, including possible torsion, medically refractory tuboovarian abscess, intra-abdominal hemorrhage with hemodynamic instability, or possible ectopic pregnancy. Further evaluation of other masses, including additional imaging or tumor markers may be indicated, especially if masses are complex, solid, or have features characteristic of benign or malignant neoplasms. Otherwise, expectant management and surveillance allow for spontaneous resolution of most masses, especially cystic masses, and prevents unnecessary surgical intervention with its potential risks and sequelae. Laparoscopy can be done in many patients, and conservative, adnexal-sparing surgery should be encouraged when possible. In addition, physicians should be familiar with signs and symptoms of postoperative complications to allow for early diagnosis and intervention.