......Continuation on FEMALE FERTILITY

PELVIC INFLAMMATORY DISEASE (PID)



Pelvic inflammatory disease (PID) is an infection of the reproductive organs occurring when bacteria travels through cervix to the uterus and the fallopian tubes.

PID can cause infertility, ectopic pregnancy, chronic pelvic pain, tubal or ovarian abscess, adhesions, peritonitis and perihepatitis. In rare cases, untreated PID can lead to death.

Pelvic inflammatory disease can be acute (sudden severe symptoms) or chronic (Long term with less intense symptoms) or silent (no symptoms).

With PID, the presence or lack of symptoms does not indicate how much damage the reproductive organs sustain. It is possible to have no symptoms and have serious blockages and adhesions leading to infertility. Some women will only discover they have PID after trying to conceive unsuccessfully or after experiencing an ectopic pregnancy.

Because many cases of PID are silent and involve no symptoms, PID is often missed or undiagnosed. The actual number of PID is likely to be higher than diagnosed.



What Causes PID

PID is caused by sexually transmitted diseases (STD). Common causes include Chlamydia and gonorrhoea. Chlamydia is a common cause of silent PID which means many women do not know they are infected.

If you have undiagnosed STD, your risk of PID is higher any time the cervix is open and infection can potentially enter the uterus.

You have a higher risk of PID after childbirth, miscarriages, abortion, endometrial biopsy, IUD insertion, HSG, Hysteroscopy.



How Does PID cause Infertility?

Between 10 – 15% of women with acute PID become infertile. If a woman has multiple episodes of acute PID, her risk of developing infertility rises.

The most common cause of PID related infertility is blocked fallopian tube. The tube typically becomes blocked from adhesions caused by the inflammation, and the blockage is usually found closer to the ovaries than the uterus.

When the blockage is near the ovaries, it is more difficult to treat surgically.

PID may also cause hydrosalpinx. This occurs when a tube is blocked near the ovary and then dilates and fills with fluid. The presence of hydrosalpinx can decrease the chances of a successful IVF treatment.

Ectopic pregnancy can also be caused by PID related damages. If you undergo surgery to repair tubal damage caused by PID, your risk of ectopic pregnancy will also be higher.

In the past, some doctors treat chronic PID with hysterectomy, but this is less frequently necessary. If your doctor suggests hysterectomy for chronic PID, you should seek a 2nd opinion.



Symptoms of PID

Symptoms of PID differ from person to person depending on whether or not they are experiencing acute, chronic or silent PID. The most common symptom is pelvic pain. Pelvic pain during intercourse (dyspareunia), lower back pain, irregular menstrual bleeding, unusual vaginal discharge, problem with urination, flu like symptoms, fatigue, fever, chills, weakness or swollen lymph node, lack of appetite, diarrhoea and vomiting and infertility.

Many of the symptoms can be mistaken for other diseases such as endometriosis, appendicitis and urinary tract infection. It is important to be upfront with your doctor if you suspect you may have contracted STD or you have other risk factors for PID, like a recurrent miscarriage, abortion, childbirth or IUD insertion.

If you are experiencing regular pelvic pain or pain during intercourse, and your doctor has not been able to diagnose or treat the problem successfully, you may wish for a 2nd opinion.

Keep pushing until you find appropriate treatment for your symptoms because your future fertility and overall health depends on it.


How is PID Diagnosed?

Doctors diagnose PID by assessing your signs and symptoms, analysing vaginal and cervical cultures, conducting urine and blood tests. Performing pelvic examination and evaluating vaginal discharge.

Whilst vaginal culture will usually uncover STD, or other bacterial infection, they will not always detect infection in fallopian tubes and uterus.

Other tests include pelvic ultrasound and diagnostic laparoscopy.



Prevention of PID

Since PID is caused by sexually transmitted disease (STD), it is preventable.

Unprotected sex with multiple partners increases your risk of getting PID.

If you are not in a committed and stable relationship with a partner who has tested for STD, practising safe sex by condom and regular STD testing is essential.

Testing for STD before insertion of IUD is important as insertion can lead to PID if you already have an STD.

Douching increases the risk of PID. Douching alters the natural flora and pit of the vagina, thus increasing the risk of vaginal infection. Douching also negatively imparts cervical mucus which is important when trying to conceive.

Invasive fertility testing like HSG, Hysteroscopy and fertility treatment involving the cervix and uterus can lead to PID if you have undiagnosed STD. This is the reason most fertility clinics conducts STD testing and vaginal culture before fertility testing and treatment.




Treatment of PID

Oral antibiotics are most often used to treat PID.

Determining which organism is causing PID might be difficult and sometimes more than one kind of bacteria may be involved. For these reasons, you may be prescribed two or more antibiotics to take at once.
Because of serious complications and damages to your fertility, treatment is often started before all the results are back. The results may however indicate a different antibiotic is necessary for treatment, so your doctor may change your treatment midway.

Antibiotic may be given by injection as well. Whilst you may feel better after a few days of antibiotics, it is important that you complete your antibiotics regimen days. Not doing so may lead to the bacteria becoming resistant and difficult or impossible to treat.




Your sexual partner must also be treated to prevent re-infection even if they have no symptoms.
Use a condom during the treatment of you and your partner.In some cases surgery may be necessary to treat abscess or particularly painful adhesions.