The truth about pelvic inflammatory disease (PID)
Infection is never fun - fever, pain, feeling like you're wading through treacle. But when it sets up camp deep inside your pelvis, at the heart of your womanly organs, it can be particularly hard to take.
Your womb is connected to your ovaries via two tubes called the Fallopian tubes - eggs released by your ovary pass down these to the womb. Travel is supposed to be one-way, non-stop from the ovaries to the womb. If an egg is fertilised and attaches to the inside of one of the tubes before it reaches the womb, the result is an ectopic pregnancy. Endometriosis may be related to cells from the womb lining travelling back up the Fallopian tubes and spilling out into the pelvis. And if infection travels upwards, affecting the womb and Fallopian tubes (and sometimes the ovaries), the result is pelvic inflammatory disease.
Perhaps not surprisingly given that it's an 'inflammatory disease', pain is the most common symptom. In some cases it can be mild - and in the case of chlamydia infections may not turn up at all until you've had the infection for some time. The pain is mostly centred over the pelvic region - the lower tummy and deep down between your groins - but some people get low back pain too. Pain may be worse when you make love - usually so-called 'deep dyspareunia', which is worse on deep penetration (superficial dyspareunia, at the entrance of the vagina, is more commonly linked to vaginal problems or issues around the vaginal entrance. Some patients also get fever. The colour and smell of vaginal discharge depends largely on the cause of the infection, but about one in four people get abnormal vaginal bleeding - after sex, between periods, or heavier periods.
If you think there's any chance you might have PID, make an appointment with your doctor. The earlier it's treated, the better the chances of avoiding long-term complications. Your doctor will arrange swabs, urine (and sometimes blood) tests, and possibly an ultrasound scan of your pelvic organs. It's also very important for any sexual contacts to be treated even if they don't have symptoms, to reduce the chance of them developing problems or infecting others.
Although the infection that causes PID can usually be treated, scarring from the inflammation can cause problems in the longer term. These include ongoing pain, particularly when you make love; difficulty getting pregnant; and an increased risk of pregnancy outside the womb if you do conceive.
PID is usually caused by a sexually transmitted infection, or STI, with chlamydia high on the list, along with gonorrhoea. STIs aren't someone else's problem - we all need to take care. In England alone, there are about 440,000 people diagnosed with STIs every year, while in the USA it's about 5.6 million (excluding HPV infection which isn't included in the UK statistics.
When I was a medical student, I scarcely ever saw a case of gonorrhoea. These days, it's far from rare - and not just among young people. In the USA, about 820,000 people are infected with gonorrhoea every year and 30% of them are over 25. In the UK, it's the second most common STI after chlamydia, with more than 25,000 new cases diagnosed a year - up from about 12,000 a decade ago.
Chlamydia is also on the rise - in England, chlamydia accounts for nearly half of all STIs diagnosed and about one in 20 women are infected. In the USA, there are about 2.86 million diagnoses a year. One of the reasons it's so easy for chlamydia to spread is because unlike some other STIs, it often doesn't cause symptoms in the short term. That means your partner may have no idea they're passing it on to you, and you may not know you've got it until you develop complications like PID, fertility problems or miscarriage.
The moral of the story? Do practise safe sex and get regular STI screens if you're sexually active with a new partner. You may not think condoms are cool, but they're a great deal less hassle than PID!