Pelvic inflammatory disease and infertility

DR MAXWELL ADEYEMI

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs – the uterus, ovaries, and fallopian tubes. It may affect one of the organs or a combination. Mostly, it is caused by bacterial infection that spreads from the vagina or cervix to the reproductive organs, but can also be caused by fungal or parasitic organisms.

The risk of developing PID include:

• Sexually transmitted infections (STI), which may occur from engaging in sexual intercourse with multiple partners or without adequate protection such as use of condoms. Bacteria transmitted through sexually transmitted infections such as gonorrhoea and chlamydia, may enter the vagina with semen, and if untreated, may pass through the cervix into the uterus and then into the fallopian tubes.

• Child birth, abortions or miscarriages. In cases of childbirth, abortions or miscarriages, the cervix might not fully be closed, allowing for infection to spread more rapidly if bacteria enter into the vagina.

• Intrauterine device is a form of contraceptive placed in the womb. It can increase the risk of developing infection, which may lead to pelvic inflammatory disease.

• Endometrial biopsy is a medical procedure that involves taking of sample from the lining of the womb for analysis. This can increase risk of infection and lead to PID.

• In some cases infection from the appendix may spread to the pelvis causing PID.

• Douching is a method of washing or cleaning out the vagina with water or mixture of fluid. Douching regularly upsets the balance of good versus harmful bacteria in the vagina. This can increase the risk of developing infections and subsequently PID.

Symptoms of PID

Most often, women with PID have no symptoms. But if they do, it can vary from mild to severe.

• Pain, especially in the pelvic area, sometimes in the lower back, rectum.

•Pain during sexual intercourse.

• Unusual vaginal discharge (may be foul smelling depending on cause).

•Frequent urination

•Fever, fatigue, vomiting

•Bleeding or spotting between periods

• Irregular menstruation

PID, if not properly treated can lead to repeated episodes. It could be as a result of sexual partner not being tested and treated. If an episode of PID damages the womb of fallopian tubes, it can become easier for bacteria to infect these areas in the future, making it more likely that PID develops again. Repeated episodes of PID are associated with an increased risk in infertility.

PID and infertility

PID, if left untreated or not properly treated, may cause complications and have damaging effects on the female reproductive system, such as scarring in the fallopian tubes or ovaries. Scarring in the tubes prevents eggs from passing through into the womb, resulting in infertility. PID can sometimes cause a collection of infected fluid called abscesses to develop, most commonly in the fallopian tubes and ovaries. These cause blockage, and just like scarring, prevents the egg from easily passing through, making pregnancy difficult.

In some cases fertilised egg may get stuck in the tube and begin to grow. This is known as ectopic pregnancy, in which case the fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. This can cause the tube to burst leading to internal bleeding.

PID can be diagnosed by:

Pelvic examination

Vaginal samples of the vaginal discharge for culture and sensitivity

Blood tests

Ultrasound scan

Treatment of PID must be prompt and is often started without confirmation of infection because of the serious complications that may result from delayed treatment. Treatment depends on the causative organism and generally involves the use of antibiotics. Self-medication is not recommended as improper use of antibiotics may cause resistance and recurrent infection.

Prevention of infertility

Although prompt treatment of PID is highly recommended, prevention is always better than cure. Regular testing for PID is encouraged. The risk of PID can be reduced by the following:

-Abstinence

-Use of condoms.

-Monogamy.

- Seeking medical attention if you are experiencing symptoms of PID.

-The use of contraceptive pills has been found to thicken the cervical mucosal plug and prevent the ascent of causative organism from the lower genital tract.

-Seeking medical attention after learning that a current or former sexual partner has, or might have had a sexually transmitted infection.

- Getting a STI history from your current partner and strongly recommending they be tested and if need be treated before intercourse.

-Diligence in avoiding vaginal activity, particularly intercourse after the end of a pregnancy or certain gynaecological procedure, to ensure that the cervix closes properly.

The effect of the PID infection may remain permanent even when the infection has been properly treated, this makes early detection and treatment very essential.

Contact Dr Maxwell at 363-1807 or 757-5411