Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID), involves inflammation and infection of the upper female genital tract, and according to Dr. Jonathon Ross, Professor of Sexual Health and HIV, is associated with infertility, ectopic pregnancy, abscess formation, and with pelvic pain. PID one of the most common infections in women of child-bearing age, and PID is the most common gynecological reason for admission to hospital in the US. Statistics from this systematic review (you can access the full article here) include that about 20% of women with PID develop infertility, 40% develop chronic pelvic pain, and 1% will have an ectopic pregnancy. Risk factors for acquiring pelvic inflammatory disease include young age, reduced socioeconomic status, and new sexual partner. It is also not uncommon for a patient to have a recurrence of PID, and this increases the risk of infertility significantly.

Dr. Ross cites a case control study that demonstrates that a delay in care of 3 days can significantly increase the risk of infertility in women, therefore it is very important to screen the patient who may be at risk for pelvic inflammatory disease. The most important factor to consider is whether or not the patient (who may be seeing you for her pelvic pain) has been seen by a medical provider. In the medical office, the patient may have testing completed to rule out sexually transmitted diseases (STD's), or have a pelvic examination done to check for typical tenderness in the pelvic organs. Unfortunately, pelvic inflammatory disease can be a "silent" disease, according to the literature, so it is important to keep in mind that even if a patient has seen a medical provider, a return visit may be warranted if the patient's condition is worsening, is failing to improve, or if you learn more information about the patient's history that makes you more concerned about the possibility of PID. This might include finding out that the patient does have a history of an STD, has multiple partners, or has had a recent history of a change in sexual partners.More obvious signs and symptoms of pelvic inflammatory disease according to the Center for Disease Controlcan include fever, vaginal discharge with odor, painful intercourse, painful urination, irregular periods, and possibly right upper quadrant abdominal pain.

The fact that pelvic inflammatory disease can have such profound consequences on a woman's health should keep the pelvic rehabilitation provider alert to the possibility of such infections in our patients. While we rely upon the medical provider to screen for such disease, we are responsible to listen well, ask relevant questions (often asking them again on repeat visits) so that we can get a patient to medical evaluation quickly if we suspect that a patient could have an active infection requiring medical intervention.