P.I.D. is an acronym for PELVIC INFLAMMATORY DISEASE, which is an infection of the female reproductive organs. These are the fallopian tubes, the ovaries, the uterus, of which the cervix is a part, and it may also involve the ligaments and connective tissue which hold them together in the pelvic area.
It usually occurs when sexually transmitted bacteria spread from your (the woman’s, of course) vagina to the uterus and upper genital tract. PID can also occur when bacteria travel up a contraceptive device or when they’re introduced during gynecological procedures such as a “dry operation”, insertion of an intra- uterine device (IUD or coil) or a back alley abortion.
Many women with PID experience no signs or symptoms and do not seek treatment. The infection may only be detected later when a woman can’t get pregnant and learns that her reproductive organs have been damaged, or when she develops chronic pelvic pain.
WHAT DOES THE WOMAN EXPERIENCE?
Her signs and symptoms may include:
• Pain in the lower abdomen and pelvis, which houses the reproductive organs..
• Heavy vaginal discharge, sometimes with an unpleasant odor.
• Pain during intercourse (dyspareunia).
• Low back pain.
• Irregular menstrual bleeding.
• Fever, fatigue, diarrhea or vomiting.
• Dysuria – painful or difficult urination.
Signs and symptoms may be minor or even non-existent. In fact two-thirds or 66% of the time, nothing is felt or seen.
Asymptomatic PID is especially common when Chlamydia is the cause. This makes it more likely that 1) you’ll pass it on to a partner, just as is the case with HIV, and 2) you’ll suffer serious damage to your reproductive organs.
Emergency signs and symptoms include:
• Severe pain in your lower abdomen
• Signs of shock, such as fainting
• Fever with a temperature higher than 101 F (38.5 C).
Casualty is where you ought to be in these situations.
WHAT CAUSES PID?
Unsafe sexual practices that increase the likelihood of getting a sexually transmitted disease (STD) – multiple partners, no condom – increase your risk of PID. The most common causative bacteria are those that cause gonorrhea and Chlamydia infection, particularly the latter nowadays. Gonorrhea usually causes symptomatic PID.
You know, one of the more difficult things I have to do in dealing with this diagnosis to women is to have to tell them that it is the result of an STD, that they got something from their partner. Many have often been convinced 100% that they are the one and only. But the fact is that their partner got it from someone and passed it on to them. This is, of course, if they have not had a recent IUD or gynecological procedure or something. It’s just a little tough to have to disappoint a woman that way.
IUD’s may increase the risk of PID. But they are still quite safe and effective, so don’t let this turn you women off. Diaphragms and condoms reduce the risk, because they prevent those bacteria from getting past the vagina. Birth control pills do not protect against STD’s but they help protect against PID by causing your body to create thicker mucus from the cervix, making it more difficult for bacteria to reach their PID destinations.
Bacteria may also enter the reproductive tract during childbirth, miscarriage or when a piece of your uterine lining is removed for study at the lab (endometrial biopsy).
There are factors which may increase your risk of PID:
• Being sexually active younger than 25 years old
• Having multiple sexual partners
• Having had PID or any STD before
• Douching regularly, which may flush bacteria higher into your genital tract, and mask symptoms that might otherwise cause you to seek early treatment.
• Having had an IUD inserted recently.
• Using non-barrier contraceptives. (You must have a barrier against bacteria). Bear in mind what I said about birth control pills above though.
SEE THE DOC IF YOU HAVE
• Pain in your lower abdomen and pelvis
• Unusual vaginal discharge with an unpleasant odor
• Irregular menstrual bleeding
• Pain during sex (dyspareunia)
• Low back pain
• Fever, fatigue, diarrhea and vomiting
You would have noticed that these were all listed before, so I’m saying that you should go to the office or clinic whenever you have signs and symptoms.
In addition, if you have any genital sores or rash, or bleeding between menstrual cycles, an STD could be around. If you have any of these, abstain from sex (yes, you can!) and see your doc soon. Prompt treatment of an STD can prevent PID.
The doctor can usually make a diagnosis based on your signs and symptoms, an examination of your reproductive organs, and sending a sample of discharge from your cervix to the lab after collecting it on a Q-tip-like swab.
Diagnosis can be confirmed and the extent of infection determined by laparoscopy, whereby an instrument is inserted into your pelvis through a tiny cut below your navel, and your reproductive system viewed as with a camcorder, up close and personal.
Untreated PID can cause scar tissue and collections of infected fluid (abscesses) to develop in your fallopian tubes. This can cause pain and infertility. Other complications:
Ectopic pregnancy. This is where a pregnancy develops in a place other than in the uterus, usually in the tubes, because the fertilized egg can’t make its way down damaged tubes to the uterus to implant there. Life-threatening bleeding requiring emergency surgery is the problem here.
Infertility. Technically, this is the inability to conceive after one year of unprotected sex.
Peritonitis. Inflammation of the membrane lining your abdominal cavity is serious and needs intensive treatment with antibiotics.
Blood poisoning. Rarely, bacteria can invade your bloodstream, causing sepsis, and PID can give rise to inflammation and infection of your joints.
Bacteria cause it, we treat it with antibiotics, usually three at a time for up to two weeks, or as we are guided by the culture results from the lab. Both partners must be treated, otherwise re-infection occurs and an endless cycle ensues.
Surgery is necessary if an abscess ruptures or threatens to do so, or if antibiotics don’t work, or if the diagnosis is in question.
Plain and simple, adopt safe sex practices to prevent infection – condoms, one partner, you know it.
See you next week.