All about Pelvic Inflammatory Disease

Pelvic Inflammatory Disease or PID is one of those lesser-known women’s health conditions. Yet it affects a lot of women.  PID is a serious condition that can affect a woman’s ability to conceive a child. Not to mention other complications too.

Causes and Risk Factors

PID is a bacterial infection of the female reproductive system which includes the fallopian tubes, ovaries, uterus, cervix, and vagina. The bacteria concerned are of different species including those that cause sexually transmitted infections (STIs) such as gonorrhea and chlamydia.

Needless to say, the bacteria enter the body through the vagina and travel upwards, infecting the various reproductive organs one after another. If the infection spreads to the blood, the condition can become life-threatening. The bacteria can come from unprotected sex and also due to objects inserted into the vagina for various purposes.

So a full list of causes would include:

• Being sexually active and less than 25 years of age
• Unprotected sex
• Sex with multiple partners who may or may not use protection
• Not using barrier contraceptives such as a condom or IUD
• An IUD or intra-uterine device that is infected at the time of insertion
• Using sex toys such as vibrators and dildos
• Douching or cleaning the vagina with water or medicated tonics
• Childbirth, abortion and miscarriage: During all these events, bacteria can enter the body and spread infections, as the cervix is not fully closed then
• Endometrial biopsy: A sample of the endometrium which lines the uterus is taken to check for cancers. This can expose the uterus to infection
• Appendicitis: A slight risk, as the infection can spread from the appendix to the uterus
• Poor hygiene: Women who do not wash or clean up properly after using the bathroom can increase their risk for PID.

Symptoms

• Severe pain, especially in the pelvic area
• Fever and chills
• Fatigue in spite of less activity
• Heavy periods with lot of bleeding, or spotting between periods
• Irregular periods
• Pain in the lower back and glutes area (near the rectum)
• Pain during sex
• Foul-smelling vaginal discharge that is greenish-yellow in color
• Frequent and painful urination
• Nausea and vomiting

Complications

• Scarring in the fallopian tubes that can make conceiving difficult
• Recurring bouts of PID
• Severe pelvic pain that can affect one’s activities and lifestyle
• A tubo-ovarian abscess: Pockets of pus form in the fallopian tube(s) and ovary(ies)
• Ectopic pregnancy: The fertilized egg lodges itself outside the uterus causing various symptoms and complications

Diagnosis

A qualified pelvic health specialist or urogynaecologist will undertake one or more of the following to confirm or rule out PID and assess the extent.

• Face-to-face discussion: The doctor will understand the person’s medical history, lifestyle, sex-life, birth control methods used and any other relevant information.
• Signs and symptoms: He/she will check for all the signs and symptoms the person is experiencing, and determine how severe is the condition
• Pelvic exam: The doctor will examine the pelvic area for tenderness or swelling. A swab of the vagina is taken to check for infection from gonorrhea or chlamydia.
• Blood and urine tests: These look for pregnancy, Sexually transmitted diseases, HIV, and for white-blood cell count. WBC count indicates if there is any infection or inflammation
• Ultrasound: Similar to the one done on pregnant women. This uses ultrasound waves to generate an image of the reproductive organs
• Laparoscopy: A thin tube fitted with light and lens at one end is inserted through the abdomen to look into the pelvic area.
• Endometrial biopsy: A sample of the endometrial tissue is extracted and checked for infection or inflammation.
• Culdocentesis: Rarely used today, this procedure uses a thin needle inserted behind the vagina to extra fluid for examination

Treatment

• Oral anti-biotics: Like with any infection, anti-biotic pills are given, if the infection is moderately severe
• Hospitalization: If the infection is severe or the woman with PID is pregnant, hospitalization is inevitable. In this case, all medication is done through IV
• Surgery: If there is severe scarring in the fallopian tubes, or tubo-ovarian abscess, the gynaecologist may use a minimally-invasive procedure to drain the pus, or remove one or both fallopian tubes. Removing both tubes is rare as the woman cannot conceive thereafter.
• Treating the partner: The partner must also be checked for sexually transmitted disease, or PID in case of a female partner
• Temporarily abstaining from sex: This is a good option until the treatment is completed and all symptoms have disappeared.

Prevention

• Sex: Practice safe sex, and avoid multiple partners.
• Contraception: Avoid spermicides and birth-control pills. Use diaphragm-based methods like IUD, and condoms.
• Screening: If you are sexually active and have more than one partner, it’s good to get screened regularly for PID and STI
• Douching: Avoid douching or patting your pelvis with powder
• Hygiene: Wipe from the front to back and not the other way round. This prevents bacteria from the anus entering into the vagina
• Treatment: Once you notice any of the above symptoms, get treated immediately

Outlook

Pelvic Inflammatory Disease is a lot more common and serious than previously known. Nearly a lakh women lose the ability to conceive a child because of PID.

If you or any woman near and dear to you is showing any of the symptoms listed above, do not take it lightly and also do not panic. PID is treatable when detected on time. Rush to a reputed hospital and consult a urogynecologist there. He/she will conduct tests to diagnose the condition precisely and put you on a course of treatment for quick recovery.

Women who are sexually active or have certain health issues and feel awkward discussing them with friends and family should consult a gynecologist at a reputed hospital such as Kauvery Hospital. This will help them understand the risks they face and take the necessary steps for their health. Consulting specialists will go a long way in ensuring good reproductive and overall health in the long run. For those who prefer lady doctors, Kauvery Hospital also has a team of renowned female gynaecologists at their branches in Tirunelveli, Salem, Hosur, Trichy, and Chennai.

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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