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Pelvic Inflammatory Disease (PID)

Condition:

This is an inflammatory condition which affects the pelvic organs; these organs consist of the womb, the tubes that carry the eggs from the ovaries to the womb and the ovaries themselves. It is a disease which arises from an infection that has affected the womb and has back tracked up the tubes. The infections are commonly contracted from the sexually transmitted infections STI’s like Gonorrhoea or Chlamydia other germs can be to blame as well, and in a proportion of cases no definite cause is found.

Initially the inflammation may be mild but if left untreated can cause serious problems later in life with fertility, pregnancy, long term pain in the pelvic region and infections. PID can cause structures in the pelvic cavity to stick to each other called adhesions causing long term discomfort and pain

Fertility
:

It has been estimated that having just one episode of PID can cause damage to your fallopian tubes (the tubes the eggs pass along from the ovaries) which can reduce your fertility and can raise your chances of ectopic pregnancy. This is where the egg becomes lodged in the tube and begins to grow; this means the foetus will not survive and when the tube ruptures it can be life threatening to the mother.
The more incidences of PID that a woman contracts will have a direct result on her fertility, each attack means reduced fertility. The tubes which become infected and swell or stick together means the eggs from the ovaries either are not able to get through to the womb to be fertilized and implant or they become stuck in the tube.

Symptoms:

Some women have only mild symptoms others suffer with combinations of the following:

  1. Low stomach pains like bad period pains which occur during your menstrual cycle but at different times

  2. The menstrual periods may be disrupted and irregular, spotting may take place.

  3. Vaginal discharge which can be green or yellow with an unpleasant smell

  4. Pain during sexual intercourse

  5. Pain from the rectum

  6. Pain or burning when passing urine

  7. Feeling unwell with a temperature

  8. More toxic effects will cause vomiting and severe lower pelvic pain

  9. If Gonorrhoea or Chlamydia are to blame symptoms will appear about 10 days after your menstrual period

If the infection goes untreated, it may be able to spread to the surrounding structures in the pelvic cavity, causing peritonitis.

Diagnosis:

PID is diagnosed on clinical findings which mean the doctor will talk to you and discuss your symptoms and then give you a physical examination which means they will try to find the nature and location of the pain and discharge. Vaginal swabs may be taken to confirm the presence of bacteria. It is made more difficult when some women do not have symptoms they think are worth seeking treatment for. You need to be aware of what is “normal” for you and to be able to seek help when you experience discharge and or pain which are not normal for you.

You may be sent for an ultrasound scan to see if your fallopian tubes are enlarged or rarely  for an abscess which can form due to the bacteria present. It may be decided that a diagnostic laparoscopy would be helpful to identify the exact nature of the problem. This would involve having a general anaesthetic in hospital usually as a day case. The operation is a minor procedure and you will have a small cut in the skin made just above you pubic hair line where gas will be pumped into your abdomen this raises the skin layer away from the structures below. The laparoscope is then inserted in a small cut which is made around your belly button; the surgeon will then look around inside to see what is going on, they may take biopsies (pieces of tissue) or samples of fluid present, they may also take photographs to show you where the problem is or to reassure you that nothing adverse is going on. Your treatment will be dependant of their findings.

Treatment:

PID can often be difficult to eradicate therefore usually you will be prescribed two different antibiotics to take at the same time. You will need to take these for at least a two week period it is important to remember to take these regularly and to complete the course. You will be given pain relief medication as well and will need to rest. If the infection is severe you may need to be admitted to hospital to start with to receive intravenous antibiotics. This will involve a small cannula being inserted into a vein in your arm and the antibiotics will then be injected straight into your blood system, this is a very effective method of eliminating the bacteria.

If you are treated for PID, especially if it's caused by an STI (sexually transmitted infection) your partner will also need to be treated. If your partner is not treated, you may well be infected again. Sexual intercourse should be avoided until treatment is completed and the tests show that you are no longer infected.
 
Prevention:

  1. Always use condoms – they will offer a good degree of protection.

  2. Use Oral Dams- These prevent the bacteria entering other orifices

  3. Regularly examine yourself to be aware of what is “normal” for you.

  4. Discuss your partners sexual history prior to engaging in sexual intercourse

  5. If in doubt both partners should be tested  for STI’s prior to sexual intercourse

  6. Multiple partners means multiple chances for you to contract an STI

 

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