Pelvic Inflammatory Disease

Although your reproductive functions are orchestrated by the hormonal activity that occurs in your brain, the conception of your child — and his or her subsequent growth and development — takes place within your body. The general area that houses your reproductive organs is your pelvis — a bony structure that contains your uterus, fallopian tubes, ovaries, and appendix, as well as part of your intestines, which are encased in a semiliquid membrane called the peritoneum. Should harmful bacteria, viruses, or other microorganisms make their way into your pelvic region, any number of serious fertility-robbing infections can result. Collectively called pelvic inflammatory disease (PID), they are specifically identified as follows:

• Endometritis: inflammation of the uterus

• Salpingitis: infection of the fallopian tube

• Oophoritis: ovarian infection

• Peritonitis: the most extreme form of PID, resulting in an infection of the entire pelvic cavity and the membrane surrounding the abdomen. Although technically almost anything that allows harmful microorganisms to pass through your vagina and into your reproductive tract has the ability to bring about PID, there are several key factors that experts have observed (and I personally have found) to be most often responsible for these infections:

• Untreated sexually transmitted diseases (STDs) like gonorrhea and chlamydia

• Use of an IUD

• A ruptured appendix

• An abortion performed under unsterile conditions

PID - THE SIGNS

The most obvious sign of PID is extreme pelvic pain, which can either build over a period of time or be sudden and severe. Other warning signs can appear as well:

• Odorous vaginal discharge

• Painful urination

• Uterine bleeding

• Fever and chills

• Nausea and vomiting

Sometimes a woman with PID has no symptoms whatever or no more than a slight backache.

HOW PID AFFECTS YOUR FERTILITY

When diagnosed and treated early on, PID will usually not have a permanent effect on your fertility. However, as I often caution my patients, once these infections make their way inside your reproductive tract, there is always a chance for serious damage.

• If left untreated, the infections can cause your organs simply to deteriorate from disease, and their removal may be the only alternative. (Fortunately, the pain leading to this drastic stage is generally so severe that most infections are caught before surgery is necessary.)

• Even when cured, infections can leave scar tissue capable of blocking sperm and egg transport. Scarring can occur anywhere the diseased tissue lived, but the most common sites are the inside lining of the fallopian tubes and the fimbria. If the scar tissue damage is severe, the fimbria can actually seal shut (a condition called clubbed tubes), in which case all chances for natural conception are lost.

PROTECTING YOUR FERTILITY FROM PID

The best way to protect your fertility from the ravages of PID, of course, is to be on the lookout for its earliest signs and symptoms, especially vaginal discharge and pelvic pain, and then seek treatment immediately. Sometimes your doctor can see or feel the presence of PID infections during your regular pelvic exam; at other times, a procedure called culdocentesis may be needed to lock in a diagnosis. Your doctor inserts a thin needle through your vagina into your abdominal cavity to aspirate fluid that is then tested for infection. In some extreme cases, I have found that a laparoscopy, a simple surgical technique that allows the doctor to view all the reproductive organs, is also helpful in confirming a diagnosis.

Once the diagnosis has been made, an antibiotic regimen taken for two to three weeks can help cure PID or check its spread. If need be, laser surgery can be performed later to help free the system of any scar tissue the infections may have left behind.

In addition, I have seen the following suggestions help protect many high-risk patients from contracting PID infection:

• Always use condoms when having sex with a high-risk partner (one who might have multiple partners or who displays any physical evidence of possible infection, especially abnormal penile discharge.

• Seek testing for STDs if you have had sex with someone you don't know well.

• Remain aware of the symptoms of all STDs, and get tested at the first sign of infection.

• Recognize your high-risk factors: PID occurs more frequently if you are under age twenty-five, you have had a sexually transmitted disease and/or PID in the past, or you use an IUD.

IF YOU HAVE HAD PID IN THE PAST...

Don't panic now. As long as you received treatment, chances are your reproductive system did not suffer fertility-related traumas. However, I must caution you that because PID can leave behind an abundance of scar tissue, which can affect your ability to conceive, it may be a good idea to have your fertility checked right now even if you are not planning a pregnancy. Your doctor can do this with a simple procedure called a hysterosalpingogram, a special x-ray of your uterus and fallopian tubes.

If scar tissue is found, laser surgery can usually remove all traces and restore your fertility to optimum potential.