The painful pilonidal cyst, perhaps this is where we derived the expression “pain in the butt”.  My first clue when suspecting a pilonidal cyst is when the student states he “I have a pimple or something on the top of my butt crack that hurts”.(I use he because thus far I have seen three students with this condition and they were all male and they all described their problem in the same way). When I did research on pilonidal cysts I did find out that it usually occurs in young white males. The word pilonidal actually means “hair nest”.  The condition is congenital and occurs in the lower sacral area. Hair often grows out of the sinus cavity. There are usually no symptoms until the cyst becomes infected. Symptoms do not often occur until young adulthood. A physician’s treatment usually consists if incision and drainage along with antibiotic therapy. If the cysts persists, an excision may be performed.