Pelvic inflammatory disease (PID) is an infection that affects the female reproductive organs. The Female reproductive organs include the Vagina, Uterus, Fallopian tubes and Ovaries. This infection occurs when sexually transmitted bacteria spreads from the vagina to the uterus, fallopian tubes or ovaries, that is, PID spreads by sexual contact with a person who has a sexually transmitted infection.

Causes of Pelvic Inflammatory Disease

Women typically get PID through unprotected sexual intercourse because sex may allow bacteria enter the reproductive system where they infect the organs there. Usually, the cervix keeps bacteria from spreading deeper to other reproductive organs but when the cervix is infected from a sexually transmitted infection or untreated sexually transmitted infection e.g., Chlamydia or Gonorrhea (those are the two most common STIs that causes pelvic inflammatory disease), the cervix is less able to protect the other reproductive organs. The cervix is the lower, narrow end of the uterus that connects the uterus and vagina. Other causes of pelvic inflammatory disease include:

  1. Pelvic procedures e.g., pelvic surgery
  2. Abortion: PID can occur after an abortion or miscarriage, or any other procedure that opens the cervix because the opening allows the bacteria to gain easy access to the reproductive organs.
  3. Childbirth: Although this is rare. Childbirth process can allow bacteria in the vagina travel up to the reproductive organs and cause PID.
  4. Insertion of an intrauterine device (IUD): This is because microbial agents can be introduced temporarily into the uterus during IUD insertion, which in turn increases the risk of the woman developing pelvic inflammatory disease during the first 20 days after insertion.

Risk Factors of Pelvic Inflammatory Disease

The factors the increases a woman’s chance of developing pelvic inflammatory disease include:

  1. Being sexually active and younger than the age of 25 years
  2. Having multiple sexual partners
  3. Has past history of pelvic inflammatory disease
  4. Has past history of sexually transmitted infection (STI)
  5. Having unprotected sexual intercourse
  6. Having sexual intercourse with an unfaithful partner, especially unprotected sex
  7. Douching: This can cause imbalance between the good and harmful bacteria in the vagina and flush up the bacteria into the reproductive tract.

Signs and Symptoms of Pelvic Inflammatory Disease

The signs and symptoms of pelvic inflammatory disease can be mild and some women may not experience any symptoms until they develop chronic pelvic pain. Signs and symptoms include:

  1. Pain: lower abdominal and pelvic pain
  2. Fever
  3. Painful, frequent or difficult urination
  4. Foul smelling vaginal discharge
  5. Pain during sex
  6. Unusual bleeding from the vagina, especially during or after sex
  7. Nausea and vomiting

Diagnosis of Pelvic Inflammatory Disease

A detailed medical history is taken with combination of findings from other laboratory investigations and examinations to diagnose PID. It includes:

  1. Pelvic Examination: The pelvic region is checked for swelling and tenderness. A cotton swab is used to also take fluid samples from inside the vagina and cervix. These samples are sent to the laboratory to check for signs of a bacterial infection to know the exact bacteria responsible e.g., Chlamydia.
  2. Blood and Urine Tests: These may measure the white blood cell counts or other markers of infection. The blood test may also be used to test for sexually transmitted infections.
  3. Ultrasound: This uses sound waves to create images of the reproductive organs. Scans can identify severe pelvic inflammatory disease.
  4. Laparoscopy: A thin, light instrument called laparoscope is inserted through a small incision in the abdomen to view the reproductive organs. This is the gold standard for diagnosis of PID but it is invasive, requires anesthesia and expensive.
  5. Endometrial Biopsy: a thin tube is inserted into the uterus to get a small sample of endometrial tissue. This sample is tested in the laboratory for signs of inflammation or infection.

Treatment of Pelvic Inflammatory Disease

Prompt medical interventions can treat the infection that causes pelvic inflammatory disease but if prompt medical measures are not taken, there may be no way to reverse any damage to the reproductive tract or organs that this disease might have caused. Treatment of PID includes:

  1. Medications: Broad spectrum antibiotic therapy with Levofloxacin, Ofloxacin, Doxycycline and Ceftriaxone, etc. is used to treat pelvic inflammatory disease.
  2. Treatment of sexual partner to prevent reinfection with sexually transmitted infection.
  3. Temporary abstinence: It is advised that sexual intercourse should be avoided until treatment is completed and symptoms have resolved.
  4. Ensure adequate bed rest.
  5. Drink lots of water.
  6. Eat a healthy and balanced diet.

Prevention of Pelvic Inflammatory Disease

Abstinence (not having sex) is the only sure way to prevent pelvic inflammatory disease. Reducing the risk of pelvic inflammatory disease include:

  1. Practice safe sex: know your partner’s sexual history, have protected sexual intercourse by using condoms and limit sexual partners.
  2. Ensure regular medical checkup: Request that your partner be tested alongside. Early treatment of a sexually transmitted infection helps to prevent PID and also prevent the spread of STIs.
  3. Avoid douching or using tampons.

Complications of Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) can lead to serious problems if prompt medical interventions are not taken. The complications of PID include:

  1. Infertility (the inability to become pregnant after one year or more of regular unprotected sexual intercourse): Damage to the reproductive organ may cause infertility.
  2. Ectopic pregnancy: This is when the fertilized egg implants outside the uterus (womb).
  3. Chronic pelvic pain
  4. Tubo-ovarian abscess: This is a collection of pus that forms as a result of an infection in a fallopian tube and ovary.

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