Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a general term that refers to a bacterial infection of the female reproductive organs, including the uterus, fallopian tubes and ovaries. It is a common but serious complication of certain sexually transmitted diseases (STDs), particularly chlamydia and gonorrhea. If left untreated, PID can cause significant damage to the organs, as well as to the tissues in and around them. Serious consequences of an ignored case of PID could include ectopic pregnancy, abscess formation and chronic pelvic pain. PID is also the leading cause of infertility in women.

Causes

PID occurs when bacteria move upward from the vagina or cervix into the fallopian tubes, ovaries and uterus, and cause an infection. There are several types of bacteria that can cause PID, but most cases are associated with two very common STDs - gonorrhea and chlamydia. It is entirely possible to develop PID without having gonorrhea or chlamydia, but it is rare.

Some women are more likely to develop PID than others. A prior infection increases the risk of another episode because the reproductive organs may have been damaged the first time around. If you have had an STD or have more than one sex partner, you also run a greater risk of developing PID. In addition, sexually active women under the age of 25 are more likely to develop PID than those over 25 because the cervix has not fully matured, making young women more susceptible to the STDs that are linked to PID.

Douching can also increase your risk of developing PID. There is a chance that doing so could flush bacteria into the uterus, ovaries and fallopian tubes and cause an infection. Douching can also hide the signs of an infection. If you don't know something is wrong, you can't take the necessary steps to correct it. Also, women who have an intrauterine device (IUD) inserted may be at a slightly greater risk of PID than women who use other methods of contraception. If you are planning on having an IUD inserted, your should be tested for STDs prior to the insertion to reduce your risk of any bacteria being pushed upward through your vagina or cervix.

Signs and Symptoms

After being infected, it can take from a few days to a few months to develop PID, and symptoms of the infection can range from none to severe. When PID is caused by chlamydia, for instance, a woman may experience mild or no symptoms at all, although serious damage is being done to her reproductive organs. About two thirds of the time, such inconspicuous symptoms cause PID to go undetected by women and their doctors. The more recognizable symptoms of PID include lower abdominal and pelvic pain, fever, chills, unusual vaginal discharge, painful intercourse and irregular menstrual bleeding.

Complications

Complications from PID occur in one out of four infected women and can include ovarian abscess, chronic pelvic pain, ectopic pregnancy and infertility. An ectopic pregnancy can lead to further complications, such as severe pain, internal bleeding and even death. Furthermore, without prompt treatment, PID can cause permanent damage to the reproductive organs. Infectious bacteria can cause normal tissue in the fallopian tubes to turn into scar tissue, which can block the normal movement off eggs from the ovaries to the uterus. If scar tissue completely blocks the fallopian tubes, sperm cannot fertilize an egg and the woman becomes infertile. About one in eight women with PID becomes infertile.

Diagnosis

PID is sometimes difficult to diagnose because the symptoms are often very subtle. In many instances, women and their doctors attribute such mild symptoms to something other than PID. A diagnosis is usually based on evidence from a physical examination of the pelvic area, which may include an ultrasound to see whether the fallopian tubes are enlarged or to identify a pelvic abscess. A doctor will also check for fever, abnormal discharge and signs of chlamydia or gonorrhea. If such signs are present, a laparoscopy will be done so that the doctor may examine the internal pelvic organs and take tissue to be studied further. A laparoscopy can help the doctor rule out other possible conditions, such as appendicitis or a ruptured ovarian cyst.

Treatment

Fortunately, PID can be cured with antibiotics, but it is imperative to get treatment right away. Any damage that is sustained by the uterus, fallopian tubes and ovaries after bacteria have entered the body cannot be reversed. There are several types of antibiotics that can cure PID. Because more than one organism may be responsible for an episode of PID, it is usually treated with at least two antibiotics. Most of these are oral antibiotics and are taken for a period of 10 to 14 days. In addition, a woman's sex partner(s) should be treated with antibiotics to decrease the risk of re-infection.

In more serious cases, hospitalization may be necessary to administer intravenous antibiotics. Surgery is sometimes required in extreme cases. Complications of PID are difficult to treat, but may improve with surgery. Prevention

The best way to prevent PID is to avoid contracting chlamydia or gonorrhea. Because it is most often caused by an untreated STD, simply protect yourself from PID by protecting yourself from STDs. Here's how:

• Practice abstinence. Don't have sex. If that is an unrealistic option, try having it with fewer people. The risk of getting an STD becomes greater over time, as the number of your sex partners increases.


• Be monogamous. Try your best to maintain a long-term, mutually monogamous sexual relationship with someone who does not have any STDs, and only have sex with each other.


• Have "safer sex." Every time you have vaginal sex, use a male (latex) condom or a female (polyurethane) condom. Ask your doctor to explain how they work if you are unsure. If a condom does not work properly, it is usually because it was not used correctly.


• Educate yourself. Know that condoms do not provide complete protection against STDs, but they do decrease your chances of getting one. Also know that birth control pills, shots, implants and diaphragms may keep you from getting pregnant, but do not protect against STDs.


• Don't douche. Douching removes some of the natural bacteria in the vagina that protect you from infection and can increase your risk of getting an STD.


• Get regular check-ups. When you are sexually active, especially if you have more than one partner, get regular pelvic exams. Tests for STDs can be done during routine Pap smears. And, the earlier an STD is found, the easier it is to treat.