It is a devastating condition that can cause chronic pain and infertility.
But the majority of women have never heard of pelvic inflammatory disease.
An infection of a woman’s reproductive organs, it can affect the uterus, fallopian tubes and ovaries.
And left untreated, the consequences can be shattering.
Unbeknown to many, the disease can cause infertility, chronic pelvic pain and ectopic pregnancy (where the foetus develops outside the womb, usually in the fallopian tube).
But it is often referred to as the ‘silent epidemic’ because it can have mild or no symptoms and often goes unrecognised by women and their doctors.
And to make matters worse, delays in diagnosis put women at greater risk of long-term complications.
Pelvic inflammatory disease can cause infertility, chronic pelvic pain and ectopic pregnancy – but often causes few, if any symptoms
HOW DO YOU GET IT?
Pelvic inflammatory disease (PID) comes from an infection that travels up the cervix or vagina to infect the uterus, fallopian tubes and other reproductive organs.
A number of harmful organisms can cause it, but sexually transmitted infections (STIs) – specifically chlamydia and gonorrhoea – are responsible for about one-third to half of known cases.
WHAT ARE THE SYMPTOMS OF PELVIC INFLAMMATORY DISEASE?
Sometimes there are no symptoms. When they are present, they may include:
lower abdominal or pelvic pain
abnormal vaginal discharge
irregular menstrual bleeding
pain during sexual intercourse
painful or increased urination
So prompt treatment of chlamydia and gonorrhoea infections is essential for the prevention of potential PID.
It can also be caused by other infections – including overgrowth of normal vaginal bacteria – or following procedures such as an abortion or having a coil, or intrauterine device (IUD) inserted.
And while PID can be treated with antibiotics, they can’t reverse the scarring of the reproductive organs that the infection may have already caused.
Overall, the risk of long-term complications from PID depends on its severity and number of repeat occurrences.
A common problem is if the fallopian tubes become scarred.
This can lead to tubal factor infertility – a condition where the fallopian tubes are blocked or damaged – in between 8 per cent (after one PID occurrence) and 40 per cent of women (after three or more occurrences).
Ectopic pregnancy occurs in around 9 per cent of women with PID and about 18 per cent experience chronic pelvic pain.
THE EMOTIONAL SCARS
We explored the psychological and social impacts of PID on women’s sense of self and their relationships. We also questioned women about their health care experiences in relation to their diagnosis.
We found being diagnosed with PID was a distressing experience for most women, with fears focused mostly on future fertility.
Infertility worries influenced the way women viewed themselves. Many thought they might be abnormal, inadequate, or damaged.
Some believed they would be incapable of fulfilling traditional female roles of ‘normal’ wife and mother.
Left untreated, the consequences of the condition can be shattering – affecting confidence and relationships
The disease negatively impacted the level of intimacy and emotional closeness many women shared with their partner.
Some experienced relationship conflict or breakdown over how the STI that led to their PID was acquired.
Almost all women felt their diagnosis had negatively affected sexual aspects of their relationships.
Many had pain or discomfort during intercourse, which caused general anxiety about sex and made them engage in it less.
Partly because PID is difficult to diagnose definitively, and due to a lack of routine data collection, it’s difficult to accurately estimate its prevalence.
It’s estimated around 10,000 are treated for pelvic inflammatory disease in hospitals each year. Ten to 30 times that number are treated as outpatients.
As women with pelvic inflammatory disease often show either mild or no symptoms, it isn’t surprising the condition often goes unrecognised.
Prompt treatment of chlamydia and gonorrhoea infections is essential for the prevention of potential PID.
Figures show those most likely to be diagnosed with chlamydia are 15- to 24-year-olds.
HOW IS IT DIAGNOSED?
In some cases of PID, there are no symptoms. When present, they may include: lower abdominal or pelvic pain, abnormal vaginal discharge, irregular menstrual bleeding, fever, pain during sex or painful urination
Laparoscopic surgery, which uses a camera to examine inside the pelvis, is the best way to diagnose PID.
But its cost and limited availability means it’s not easily justifiable for women with mild or vague symptoms.
Both international and national guidelines encourage doctors to treat for PID when a woman presents with lower abdominal pain and all other causes have been excluded.
But research shows large numbers of women have a diagnosis missed or inadequately treated.
In our research, women with PID often described experiences of incorrect diagnoses, incorrect prescriptions and inadequate medical care.
Some women also reported receiving inadequate information from their health care provider about the diagnosis and management of their condition.
Women may also delay seeking treatment. We found the majority of women had symptoms for longer than four weeks before they sought medical care.
Several reported having symptoms for more than six months before they saw a medical professional.
A major contributor to this delay was a lack of awareness. Many women had never heard of PID prior to their diagnosis.
This is why safe sex is so important – as is regular STI screening and better awareness of the symptoms.
HOW A COMMON INFECTION CAN LEAD TO PID
Few have heard of bacterial vaginosis (BV) although it’s a relatively common condition.
Symptoms include a watery, milky discharge and fishy odour coming from the vagina.
Women with BV are more likely to get sexually transmitted infections (STIs) – such as chlamydia, gonorrhoea and herpes – and to transmit or acquire HIV.
They are more likely to develop pelvic inflammatory disease, a painful condition that can result in infertility.
Pregnant women with BV are more likely to suffer miscarriages and deliver premature and low birth-weight babies.
Studies have shown women’s self-esteem, sexual relationships and quality of life suffer significantly from this infection.
Women have reported BV symptoms make them feel embarrassed, ‘dirty’ and concerned others may be able to detect their odour.
Many women with BV symptoms think they are experiencing thrush, and commonly report being treated for this.
But BV doesn’t cause itching and there is often a noticeable fishy odour. Improper treatment for this condition leads to persistent symptoms, frustration and distress.