Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is characterised by infection of the female reproductive organs, such as the uterus, fallopian tubes, and ovaries. It is mostly acquired through unsafe sexual practices and is one of the most serious consequences of sexually transmitted diseases (STD). PID can cause permanent damage to the female reproductive system, and is one of the leading causes of infertility.

Causes and risks

PID can occur when you are exposed to an STD, such as chlamydia or gonorrhoea. The cervix loses its ability to protect the internal organs from bacteria and the infection eventually spreads to your uterus, ovaries, and fallopian tubes. 90% of PID occurs as a result of untreated chlamydia and gonorrhoea. Sexual practices that involve multiple partners and unprotected sex increase your chances of acquiring STDs, which can in turn lead to PID.

Symptoms

PID can show minor symptoms or no symptoms at all (common with chlamydial infection). They can often vary, but may include:

  • Dull pain in your stomach and lower abdomen and pelvis
  • Green or yellow vaginal discharge, having a distinct and often unpleasant odour
  • Pain during urination
  • Irregular vaginal bleeding
  • Fever or chills
  • Nausea, vomiting or diarrhoea
  • Pain in the lower back
  • Painful intercourse

    If you notice any of these symptoms, it is important to stop having intercourse and visit your doctor immediately, as prompt treatment is vital for PID.

Complications

Left untreated, PID can cause scarring and collection of abscesses (infected fluid) in the fallopian tubes. PID can also lead to infertility or ectopic pregnancy (implantation of embryo outside uterus). Scarring or damage can occur to other reproductive organs, which can cause chronic pelvic pain that can last for many months.

Diagnosis

Based on your signs and symptoms, your doctor may perform a pelvic examination and take swabs. Samples may be obtained from your cervix and vagina using a cotton swab, and sent to the laboratory to identify the bacteria causing the infection.

Your doctor may also recommend the following tests to confirm and determine the extent of your infection.

  • Blood tests, to analyse the infection
  • Pelvic ultrasound
  • Endometrial biopsy
  • Laparoscopy, to examine your pelvic organs

Treatment

Confirmation of PID will be immediately followed by treatment. You will be started on oral antibiotic medications for mild cases of PID. For more severe cases, you may be treated on a combination of oral and intravenous medications, or hospitalised for more aggressive management. It is important that your partner also gets treated, even if he does not have any symptoms, in order to prevent future re-infections.

If antibiotics fail to clear the infection, and if the infection forms abscesses in your uterus or ovaries, you may be recommended to undergo a hysterectomy (removal of the uterus) or an oophorectomy (removal of ovaries).

When your infection, abscess, or inflammation has cleared, but you are still experiencing chronic pelvic pain, you may be recommended to undergo nerve ablation surgery, where the nerves that provide sensation to your pelvic organs are surgically removed or destroyed.

Prevention

Prevention is the best way to deal with PID.

  • Avoid unsafe sexual practices, multiple partners, and use barrier methods, such as condoms and spermicides.
  • Avoid IUD if you have multiple partners.
  • Watch for symptoms and be prompt to get treatment.
  • Have regular follow-up with your doctor, as infections identified during the early stages can be prevented from spreading to your reproductive organs.

Avoid douching, as douching disturbs the fragile balance of bacteria in your vagina, masks your vaginal discharge, and pushes the bacteria up into the genital tract.

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