Pelvic Inflammatory Disease and Infertility
April 18, 2018
One of the medical conditions that affect a woman’s ability to conceive is pelvic inflammatory disease or PID. PID is infection of the pelvic organs which include the uterus, fallopian tubes, ovaries, and their supporting structures. The infection can spread even further, causing pelvic peritonitis. Many organisms can cause PID, but Chlamydia and gonorrhoea are among those most frequently seen. PID occurs at a rate of 25 per 100 women. About 20% of those who acquire PID will be left infertile.
PID usually begins with a cervical infection that spreads by surface invasion along the endometrium and then out to the fallopian tubes and ovaries. Such invasion is most apt to occur at the end of a menstrual period, because menstrual blood provides an excellent growth medium. There also is loss of the normal cervical mucus barrier at this time, which increases the risk for initial invasion. If left unrecognized and untreated, PID enters a chronic phase, which causes the scarring that can lead to stricture of the fallopian tubes and resulting fertility problems. But in some cases wherein the fallopian tubes aren’t blocked, an egg may implant outside the uterus and cause a dangerous condition called ectopic pregnancy. This can cause internal bleeding and even death.
As peritoneal tissue becomes inflamed and edematous, a purulent exudate forms. If the process is untreated, it enters a chronic phase and fibrotic scarring with stricture or narrowing of the fallopian tubes results. With acute PID, the woman notices severe pain in the lower abdomen. She may have an accompanying heavy, purulent discharge. As the infection progresses, she will develop a fever. Leukocytosis and an elevated erythrocyte sedimentation rate will be present on laboratory testing. During a pelvic examination, any manipulation of the cervix causes severe pain. It may be difficult to palpate the ovaries because of tenderness and abdominal guarding. If the PID enters a chronic phase, the abdominal pain lessens but dyspareunia or painful intercourse and dysmenorrhea may be extreme. If the ovaries are affected, intermenstrual spotting may occur. Diagnosis can be aided by sonography or laparoscopy.
A pelvic ultrasound, although not routinely done can be performed. This procedure can help in diagnosing other complications such as tubo-ovarian abscesses, ovarian torsion, ovarian cysts, and ectopic pregnancy.
PID is generally difficult to diagnose because symptoms are often subtle and mild.
Are there any PID treatments?
Therapy involves administration of an analgesic for comfort plus specific broad-spectrum antibiotics such as cefoxitin, doxycycline or clindamycin. Limiting activity also helps relieve the pain. In some women, a pelvic abscess forms and must be drained before healing can occur.
Women who have had one episode of PID have an increased chance of a second occurrence, because the immune protection of the tubes and ovaries may be damaged. They should not have intercourse with an infected partner, and they should avoid sex during menstruation, when their protective mechanisms are lowest.
What are the complications associated with PID that can further threaten fertility?
Tubal damage and scarring, ectopic pregnancies and ovarian abscess are all complications caused by PID and can seriously impair one’s fertility. Females diagnosed with PID are at an increased risk of getting it again. With each case, the risk of infertility is also increased.
How can PID be prevented?
By taking steps to prevent STDs, women can also prevent themselves from getting PID.
An appropriate sexual risk assessment should be frequently done by your health care provider. This helps screen women for Chlamydia infection or other infections that cause PID.
Any genital symptoms experienced should be reported to the physician immediately. This includes an unusual sore, bleeding between menstrual cycles or painful intercourse. All these could possibly be caused by and STD infection.
For those who are currently being treated for the infection, no sexual activity should take place until after the treatment process. Sexual partners pose a risk of getting infected. Individuals should also bear in mind to limit the number of sexual partners and avoid high-risk partners. Practicing safe sex by using barrier devices such as latex condoms may also help. This is the last thing women who want to conceive would do, so a thorough screening of both partners can be done prior.
Avoid frequent vaginal douching. This facilitates movement of bacteria up along the genital tract. Wipe from front to back after each bowel movement in order to keep bacteria from entering the vagina.
If diagnosed and treated early, the patient outcome is good. In women, PID is the most common cause of infertility. Prompt treatment of this disease will prevent women from having undesired infertility.