Simply put, Pelvic Inflammatory Disease is characterized by anything which may cause inflammation within the uterus, fallopian tubes or ovaries. This means that PID can have a wide range of causes from STIs (Sexually Transmitted Infections) to post-surgical issues to the IUD (Intrauterine Device). PID affects nearly 1 million women each year and nearly 10%-15% of these women may become infertile due to the disease. The remaining become more susceptible to ectopic pregnancies (pregnancies occurring outside of the uterus, usually in the fallopian tubes). These pregnancies are not viable and although over half will resolve themselves naturally without treatment, the other half may become extremely dangerous, or even life-threatening if left untreated.
PID is primarily caused by bacterial infections, but can also begin as viral, fungal or parasitic infections. The infection will generally start out in the vagina. Within the vagina the infection is able to flourish and multiply. If left untreated, the infection can then spread to other parts of the reproductive system, such as the the uterus or, from there, the fallopian tubes and even the ovaries.
The infection presents the greatest threat when it has spread to the fallopian tubes because once the infection begins to create scar tissue within the fallopian tubes it will quickly create blockages due to the narrow openings. These blockages is what causes infertility in women or lead to dangerous ectopic pregnancies.
Causes of Pelvic Inflammatory Disease:
STIs
Although not the only cause, STIs are a large contributor to the development and prevalence of PID today. This may be specifically related to the rise in cases of STIs in general. Since 1997, for instance, the number of cases reported annually of Chlamydia has increased over 100% from about 500,000 cases annually to over 1.2 million cases reported annually. Contradictory to that, the number of reported cases of Gonorrhea reported annually has remained mostly steady at around 300,000 cases reported annually.
Since both Chlamydia and Gonorrhea typically show now signs or symptoms, it is no mystery why these can develop into PID so easily. So the first and most effective means of preventing PID through an STI is simply using protection during sexual intercourse and/or, if you’re having unprotected sex, having regular gynological exams. It is our job and it is our opportunity to decrease the spread of these STIs significantly by asking our partners to wear a condom. If we can prevent the spread of these diseases by even a factor of 50% then it is certain we will see a similar reduction in the number of cases of PID each year, not to mention a sharp decrease in the number of ectopic pregnancies as well.
IUD
Initial research surrounding the IUD indicated that the instance of PID in women using an IUD was much higher than what more recent research has shown. It is believed that there was a lack of control of the groups used in the initial research, meaning the results could have shown much more drastic results than what the IUD actually causes. The more recent research has indicated that the IUD only introduces a risk of PID if an untreated STI such as Chlamydia or Gonorrhea is present. In these cases, the IUD would act to accelerate or ensure the onset of PID. For this reason, it is essential that the patient has their gynecologist perform a pelvic exam prior to the insertion of the IUD. After the first month of being inserted, the IUD will present no further threat.
Postpartum PID
PID occurs in Postpartum women in approximately 1% of cases. Once again, the most common cause of this is STIs. Due to the unique changes to the body and hormones, the women is more susceptible to STIs during the 12 months following pregnancy. For this reason, it is even more important to have regular gynecological screenings in the 12 month period following your pregnancy.
However, that is not the only cause. If you encountered any complications during the pregnancy or during delivery, this may also cause PID. In the event that a complication should cause scar tissue to develop within the reproductive system, it is possible for PID to also occur. For this reason, if you had complications during your pregnancy, during delivery, or following delivery, you should consult your gynecologist for a more thorough exam.
Postabortal PID
Similar to Postpartum PID, if a pregnancy is terminated or if the woman experiences a miscarriage the body may be more susceptible to STIs following due to a change in the hormones within the body. However, due to the procedure involved with terminating a pregnancy, there may be an increased risk of infection or an increased risk of damage within the reproductive system which could cause additional scarring.
Can Pelvic Inflammatory Disease Be Cured?
Since PID is merely the inflammation experienced from the infection, PID itself can be cured. However, the scarring created within the reproductive system by the infection may be permanent. This will depend largely on how long the infection was allowed to spread without being treated and also the severity of the infection.
In the event that PID causes infertility in the woman there are a couple options. First, tuboplasty may be used to restore normal reproductive function. Tuboplasty is a surgical procedure used to correct an obstruction or abnormality with the fallopian tubes and may help a woman restore normal reproductive function. With medical advancements, Tuboplasty is becoming a more accepted procedure for handling PID as success rates are generally between 50-70%. If the infection spread further, into the ovaries, and tuboplasty is not possible, or if tuboplasty is not an option for some other reason, then IVF is still a viable means of becoming pregnant. IVF (Invetro Fertilization) is the procedure of implanting a fertilized egg within the female. Success rates of IVF will vary depending on a number of factors, including age. On average, women under 35 saw a success rat of approximately 34% with IVF compared to a 27% success rate for women over 35.
Even if PID is cured, regular screening would be recommended on an ongoing basis as the woman may become more susceptible to chronic PID.
Final Thoughts
Pelvic Inflammatory Disease may be one of the scariest causes of infertility in women for no other reason than the fact it affects 1 million women annually. Some people might say that we can’t live our lives in fear, but that’s not what I’m suggesting. The fact is that PID causes more cases of infertility in women annually than anything else, yet is entirely preventable. As women we need to take a stand for ourselves and understand that with our actions alone we can drastically decrease the instances of PID annually simply by reducing the cases of STIs such as Chlamydia and Gonorrhea by practicing safe sex. Also, as parents I feel it is our duty to talk to our kids about sex, and safe sex, and remove the negativity we associate with sex and, instead, have them understand the great responsibility that comes with having sex and the dangers of having unprotected sex. Then, if we take that same understanding and that same responsibility to heart, PID will become a much less devastating cause of infertility in women. In the end, it is our choice that makes a difference.