Pelvic Inflammatory Disease

Pelvic Inflammatory Disease, known as PID for short, covers a variety of infections of the upper genital tract in women. It has different names depending on the site of infection; for example, it's called endometritis (not to be confused with endometriosis), when the endometrium (inner lining of the uterus) is affected, salpingitis when the Fallopian tubes are involved, and, when the inflammation spreads inside the abdominal cavity surrounding the reproductive organs, it's called pelvic peritonitis. It is estimated that at least 1 woman in 10 in Canada have had at least 1 episode of PID in the course of her life. Untreated PID can result in ectopic pregnancy or tubal infertility.

Symptoms

Depending on the origin of the infection, the symptoms of PID can range from mild to severe. They tend to develop gradually and may include:

  • a vaginal discharge green or yellow in colour, possibly bloody and/or having an unpleasant smell
  • dull pain or tenderness in the stomach, pelvic region, or right upper abdomen
  • irregular periods
  • chills, high fever
  • cramping throughout the month
  • pain during sex
  • nausea, vomiting

Very occasionally, a woman with PID won't have any symptoms at all.

Cause

PID is caused by a bacterial infection that is usually acquired during sexual intercourse, and most of these cases are linked to the bacteria Neisseria gonorrhoeae or Chlamydia trachomatis, which produce gonorrhea (the "clap") and chlamydia respectively. PID can also be caused by bacteria acquired during an abortion, a pelvic procedure such as the insertion of an IUD, or a birth. In any case, the bacteria moves up from the cervix into the upper genital tract and can infect the uterus, ovaries, Fallopian tubes, or related structures.

Diagnosis

If you think you might have PID or an STI, visit your doctor as soon as possible. A preliminary diagnosis may be based on your symptoms, a pelvic exam (with the doctor taking a swab for testing), and your previous medical history: If your doctor finds you have pain or abdominal tenderness when touching your cervix and a history that includes an STI, treatment will likely be started even before any test results come back.

In addition, your doctor may order more tests such as:

  • blood tests to confirm presence and type of infection.
  • a laparoscopy (which involves a fibre-optic tube inserted through a small incision just below the navel) to determine the exact location of the infection.
  • an ultrasound (which involves sound waves) to get a picture of your reproductive organs.

Risk factors

The more sexual partners you have, the more likely you are to get gonorrhea or chlamydia, and consequently PID. Other factors that increase your risks of having PID include:

  • your age: if you're less than 25 years old and sexually active.
  • the insertion of an IUD (because if you already have an STI when your intrauterine device (IUD) is inserted, you may be inviting an infection - which is why you should be sure to be screened for STIs a couple of months ahead of the insertion).
  • previous episodes of PID

Treatment

If a preliminary diagnosis suggests PID, your doctor will probably prescribe antibiotics - 2 kinds - to cover the wide range of infectious agents that may be responsible. In addition, most doctors require a return visit within 2 or 3 days later to ensure that the antibiotics are doing their job.

Some women with PID require hospitalization in order to receive antibiotic treatment intravenously. Usually this is because they are very sick, are under 18 years of age, are pregnant, or have HIV.

If you are diagnosed with PID, your sexual partner(s) should be tested (and treated as necessary) for STIs, or you may develop PID again.

Prevention

Since PID is primarily caused by an STI, particularly gonorrhea or chlamydia, the best protection is to use a latex or polyurethane condom, correctly and without fail, during sexual intercourse. In addition, avoid having multiple sexual partners and use barrier methods of birth control (such as condoms and/or a diaphragm, plus spermicide), even while on the pill.

Be sure to have regular gynecological checkups and screenings, especially if you are sexually active so that any cervical infection can be caught early and treated before it spreads to your reproductive organs.

Complications

Because PID can result in scarring of the Fallopian tubes, it can lead to an ectopic pregnancy (where a fetus tries to grow in the Fallopian tubes or elsewhere outside the uterus) or chronic pelvic pain. PID can also lead to infertility: About 15 percent of women who have had PID cannot conceive after 1 episode, 30 percent after 2 episodes.

If you notice any symptoms of PID or an STI, including bleeding between periods, any unusual vaginal discharge or pelvic pain, visit your doctor or go to a free clinic or local public health unit to be checked.

For more information :

The Society of Obstetricians and Gynaecologists of Canada

www.sogc.org

Sexuality and U

www.sexualityandu.ca

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