One of the major complaints that a lot of women have is chronic pelvic pain (pain lasting several months). There are a lot of causes; some more serious than others.
Pelvic Inflammatory Disease (PID) is one of the more serious reasons that women may experience Chronic Pelvic Pain.
What is PID? According to the Center for Disease Control and Prevention (CDC) around 750,000 each year experience an acute case of PID.[i] It refers to a serious complication related to bacterial infection that moves from the vagina into the uterus and fallopian tubes. This infection can cause scarring and blockage of the fallopian tubes leading to infertility.[ii]
Symptoms of PID: Symptoms of PID include the following:
- Pain in your lower abdomen and pelvis
- Heavy vaginal discharge with an unpleasant odor
- Irregular menstrual bleeding
- Pain during intercourse
- Low back pain
- Fever, fatigue, diarrhea or vomiting
- Painful or difficult urination
While these symptoms are readily apparent PID may cause only minor symptoms or none at all. Asymptomatic PID is especially common when the infection is due to Chlamydia.[iii] If you are experiencing any of these symptoms, or suspect you have been exposed to a Sexually Transmitted Disease like Chlamydia, you should contact your doctor to be checked immediately.
More urgent symptoms that indicate the need to go to the emergency room which are linked to PID are:
- Severe pain low in your abdomen
- Signs of shock, such as fainting
- Fever, with a temperature higher than 101 F (38.3 C)
Diagnosis of PID is very important in order to avoid complications like infertility, however it can be difficult. There is no specific test for PID because if can be caused by several different types of bacteria and symptoms may be subtle and easy for women and doctors to miss.
If you come to your GYN with symptoms such as lower abdominal pain, your provider may perform a physical examination to determine the nature and location of the pain and check for fever. They will also ask about abnormal vaginal or cervical discharge, and for evidence of gonorrheal or Chlamydial infection. If the findings suggest PID, treatment is necessary.[v]
Your OB/GYN may also order a pelvic ultrasound. An ultrasound can allow the sonographer and doctor to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a procedure in which a thin, rigid tube with a lighted end and camera is inserted through a small incision in the abdomen, usually in the belly button. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.[vi]
The basic treatment for mild cases of PID is a course of antibiotics. In most cases this will clear up the infection, however, it cannot reverse scarring and damage already caused by PID. For this reason it is key that women seek treatment as soon as they suspect there is a problem. Doctors will often prescribe a course of two antibiotics together because it is difficult to determine which bacteria are responsible for the PID. They often will ask patients to come back in with in a week for re-evaluation to make sure that the infection is responding to treatment. It is also appropriate for all sexual partners to be treated as well because they may not have symptoms, but may still be carrying dangerous bacteria.
According to the CDC, Hospitalization to treat PID may be recommended if the woman:
1. Is severely ill (e.g., nausea, vomiting, and high fever)
2. Is pregnant
3. Does not respond to, or cannot take, oral medication and needs intravenous antibiotics
4. Has an abscess in the fallopian tube or ovary (tubo-ovarian abscess)
5. Needs to be monitored to be sure that her symptoms are not due to another condition that would require emergency surgery (e.g., appendicitis). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes improve with surgery.[vii]
[i] Center for Disease Control & Prevention. “Pelvic Inflammatory Disease – CDC Fact Sheet” in Center for Disease Control and Prevention, Sexually Transmitted Diseases march 25, 2011. http://www.cdc.gov/std/pid/stdfact-pid.htm
[v] Center for Disease Control & Prevention. “Pelvic Inflammatory Disease – CDC Fact Sheet” in Center for Disease Control and Prevention, Sexually Transmitted Diseases march 25, 2011. http://www.cdc.gov/std/pid/stdfact-pid.htm