There are often a number of patients who come to the author for consultation will directly say that they suffer from pelvic inflammatory disease, and a long time multi-treatment has not been cured, and some patients feel that their pelvic inflammatory disease not only does not cure and the more treatment symptoms more serious, do not know how to be good. Why do these patients get worse and worse? This is where we start with the proper diagnosis of pelvic inflammatory disease: pelvic inflammatory disease refers to inflammation of the upper female reproductive tract and surrounding tissues, including endometritis, tubal inflammation, tubo-ovarian abscess, and pelvic peritonitis. Inflammation can be confined to one site or involve several sites at the same time, the most common being tubal inflammation and tubo-ovarian inflammation. There are two types of pelvic inflammatory diseases, acute and chronic. Acute pelvic inflammatory disease can develop causing severe diffuse peritonitis, systemic sepsis, infectious shock, and even life-threatening. If the acute phase is not completely cured, it can turn into chronic pelvic inflammatory disease. Chronic pelvic inflammatory disease is often persistent and can recur, leading to infertility, tubal pregnancy (ectopic pregnancy) and chronic pelvic pain, which seriously affects women’s health and increases the economic burden on families and society. The pelvic inflammatory disease is an inflammatory disease and it is important to find out what causative pathogens are causing the inflammation. The pelvic inflammatory pathogens have two sources: 1. endogenous pathogens, from the original colony of bacteria residing in the vagina, including aerobic and anaerobic bacteria, when pelvic inflammatory disease occurs can be purely aerobic or anaerobic bacteria, but a mixture of aerobic and anaerobic bacteria is common. The main pathogens are Staphylococcus aureus, Streptococcus hemolyticus, Escherichia coli, Bacteroides fragilis, Streptococcus pepticus, Streptococcus pepticus, etc. Anaerobic bacterial infections are characterized by the easy formation of pelvic abscesses, infectious thrombophlebitis, and pus with a strong fecal odor. According to the literature, nearly 80% of pelvic abscesses can be cultured with anaerobic bacteria. 2, exogenous pathogens, mainly sexually transmitted disease pathogens, such as Chlamydia, gonorrhea bacillus and mycoplasma, and other Mycobacterium tuberculosis, rare Pseudomonas aeruginosa. In the last 20 years, a large body of literature from home and abroad has reported that acute pelvic inflammatory disease is caused by the main pathogens of sexually transmitted diseases: gonococcal and chlamydial infections. Since sexually transmitted diseases are often associated with both aerobic and anaerobic bacterial infections. Injuries to the fallopian tubes caused by gonococcal or chlamydial infections can easily lead to secondary aerobic and anaerobic infections and abscess formation. At present, it is still debated whether mycoplasma can cause inflammation of the genital tract alone, but the author, in his long-term clinical work, has often been able to culture both chlamydia and mycoplasma in the genital tract secretions of gonorrhea patients, and when gonorrhea and chlamydia infections are cured, mycoplasma can also be examined and cultured. It is evident that mycoplasma infections are always present and difficult to cure. The symptoms of acute pelvic inflammatory disease are obvious and its diagnosis is relatively easy. Although there are different degrees of symptoms and signs depending on the length of onset, the size of the inflammatory spread, and the causative agent (e.g., gonorrhea bifidum is severe), even mild cases can be asymptomatic. But the most common symptom is lower abdominal pain, abdominal pain is persistent, aggravated by activity or after sexual intercourse; followed by fever, if the condition is serious, there may be chills and high fever, headache, loss of appetite; if it develops into peritonitis, nausea and vomiting, abdominal distension, diarrhea, etc., mistaken for acute gastroenteritis. The author has seen many patients with acute gonorrhea pelvic inflammatory disease on duty in the emergency department, all of whom were mistaken for acute gastroenteritis and went to the internal medicine department. There are also many patients with acute pelvic inflammatory disease who go to urology because of bladder irritation symptoms, such as frequent urination, urgency, shortness of urine and painful urination. The reason for this is because acute pelvic inflammatory disease has abscess formation and the inflammatory irritation symptoms caused by the local compression of the uterine bladder by the abscess mass located in front of the uterus. In this case, not only the urinary tract is infected, but also a serious infection has occurred in the pelvic cavity. The gynecological symptoms include an obvious increase in vaginal discharge, the patient finds out on her own that her leucorrhea is purulent and drips out continuously when she goes to the toilet, and the doctor can detect the causative agent through microscopic examination of vaginal fluid and culture of the causative organism to guide medication. In the case of menstruation, there is an increase in menstrual flow and prolonged periods. Symptoms appear differently depending on the infecting pathogen. Gonococcal infection has a rapid onset, may be febrile, and often causes pus accumulation in the fallopian tubes, signs of peritoneal irritation, and large amounts of purulent vaginal discharge. Non-gonococcal pelvic inflammatory disease has a slower onset, and although the signs of peritoneal irritation are less pronounced than in gonorrheal pelvic inflammatory disease, anaerobic infections often form abscesses in the pelvic cavity, and symptoms such as diarrhea, urinary discomfort, and lower abdominal distention and pain may occur. Chlamydial infections are longer term and can be completely asymptomatic and persistent. The symptoms of acute pelvic inflammatory disease, especially after the formation of a pelvic abscess, although obvious, must also be distinguished from other acute abdominal conditions to avoid delayed treatment, such as acute appendicitis (appendiceal abscess, peritonitis), tubal pregnancy abortion, rupture hemorrhage, ovarian cyst torsion or rupture, etc. Chronic pelvic inflammatory disease is often the result of acute pelvic inflammatory disease that has not been completely cured or is prolonged by the patient’s poor health. Chronic pelvic inflammatory disease often causes lower abdominal swelling and lumbosacral pain due to scar adhesions and pelvic congestion, which can be evident around the time of menstruation. Chronic pelvic inflammatory disease can cause increased menstrual flow due to pelvic stasis; menstrual disorders due to ovarian dysfunction caused by chronic inflammation involving the ovaries; and irregular vaginal bleeding due to chronic inflammation of the endometrium. Chronic pelvic inflammatory disease leads to infertility or ectopic pregnancy (ectopic pregnancy). The systemic symptoms of patients with chronic pelvic inflammatory disease are not obvious. A few patients may have painful intercourse, low fever in the afternoon (hot flashes), and very few patients may have symptoms of neurasthenia, insomnia, easy fatigue, mental discomfort, and peripheral discomfort, etc. The majority of patients are found when they come to the clinic because of infertility. A history of acute pelvic inflammatory disease with untreated and recurrent symptoms is the main basis for the diagnosis of chronic pelvic inflammatory disease, but many patients have more self-conscious symptoms without an obvious history of pelvic inflammatory disease and positive signs (e.g. endometritis; tubal adhesions obstruction, hydrocele; pelvic adhesions, etc.). In the event that the diagnosis of chronic pelvic inflammatory disease is made rashly, the diagnosis of chronic pelvic inflammatory disease must be made cautiously, so as not to be able to treat the patient’s self-conscious symptoms and constantly aggravate the patient’s mind and form neurosis. Sometimes pelvic congestion or varicose veins in the broad ligament can also produce symptoms similar to those of chronic pelvic inflammatory disease. The author often has many patients who come to the clinic complaining of pelvic inflammatory disease for a long time, but after further examination with vaginal ultrasound or laparoscopy, the author rules out chronic pelvic inflammatory disease and diagnoses it as pelvic venous stasis. It is worth mentioning that the incidence of female genital tuberculosis has increased in the last 20 years or so, with many cases of tuberculous pelvic inflammatory disease forming. This is related to the increasingly widespread population mobility in the last 20 years, the lack of systematic treatment of many tuberculosis diseases and the emergence of many multidrug-resistant tuberculosis infections, as well as to the lack of awareness of the masses, especially young and middle-aged people, about sexually transmitted diseases, AIDS and tuberculosis. Tuberculous pelvic inflammatory disease is a chronic inflammatory process that is not significantly different from the symptoms of non-tuberculous chronic pelvic inflammatory disease in general. Patients also have some symptoms such as menstrual disorders, lower abdominal cramps, low fever, weakness, loss of appetite and emaciation, which are mainly detected only after an in-depth and careful examination by the doctor when they come to the clinic with infertility. Severe tuberculous pelvic inflammatory disease is often combined with peritoneal tuberculosis, and young female patients can develop large amounts of ascites, form encapsulated effusions, etc., and detect cystic masses or ascites signs during ultrasound examination. The author admitted a pregnant woman with respiratory distress in the fourth month of pregnancy 20 years ago. After admission, the examination revealed that the patient had a large amount of ascites, which was pushing up the diaphragm, as well as bilateral pleural fluid at the rib angle, so it caused respiratory distress. Later, the pregnant woman was first given the fetus to be induced and then continued the anti-tuberculosis infection treatment for six months, and two years after curing the tuberculosis, she gave birth to a child as she wished. This type of case is common in the author’s medical experience. The vast majority of patients with tuberculous pelvic inflammatory disease do not have obvious symptoms of acute pelvic inflammatory disease or a recurrent course from acute to chronic infection, so the diagnosis is easily overlooked or misdiagnosed. However, what is more frightening is that if TB pelvic inflammatory disease is misdiagnosed as general non-specific pelvic inflammatory disease (commonly known as pelvic inflammatory disease) and is not treated systematically with anti-tuberculosis drugs, it will not only fail to cure TB pelvic inflammatory disease, but will also produce secondary infections with conditional pathogens and aggravate the disease. Delayed treatment can also result in lifelong infertility. In fact, according to statistics and domestic literature, the incidence of acute pelvic inflammatory disease has declined significantly in the last 10 years, and severe pelvic abscesses have become very rare, thanks to two factors: First, the body of women is now much stronger than it was 20 years ago, and due to the material abundance of society, young women between the ages of 20 and 40 are now well nourished from birth. Their infancy, childhood and adolescence are supported by rich nutrition, and their body’s resistance is naturally stronger. In addition, the hygiene conditions are very good, and they use clean menstrual pads during menstruation, so the chance for pathogenic bacteria to enter is greatly reduced. The second is that modern antibiotics are very effective, generally speaking, the common pathogenic microorganisms can not resist the action of modern antibiotics, in addition, there are a variety of antibiotics can be used and combined, creating a powerful anti-inflammatory effect of antibiotics. The treatment of acute pelvic inflammatory disease is very effective, the cure rate is very high, so the acute pelvic inflammatory disease is not completely cured, or chronic pelvic inflammatory disease caused by the patient’s poor health and prolonged course is greatly reduced. The majority of them are not true “pelvic inflammatory disease”, but non-inflammatory pelvic inflammatory disease. The vast majority of patients are not really “pelvic inflammatory” but rather have non-inflammatory pelvic stasis signs, irritable bowel syndrome, or even neurological symptoms. These patients often only complain of lower abdominal distension, lumbosacral pain, peripheral discomfort, painful intercourse, etc. When they go to the gynecologist, the doctor feels that a certain area is pressed during the “double” or “triple” examination with her fingers. “The doctor then says that this area is “thickened” and is inflammatory! The “diagnosis” of “chronic pelvic inflammatory disease” comes out. According to the diagnosis of “chronic pelvic inflammatory disease”, even if the doctor exhausts all treatment means, including medication, intravenous drip, enema, various physical wave irradiation, etc., such repeated treatment not only does not improve the abdominal pain and discomfort, but also the pelvic ultrasound examination will find that the blood vessel stasis in the pelvic cavity is getting more and more serious, so that they mistakenly believe that They may think that there is no cure for their condition, and their worries become more and more serious. When these patients came to the author for consultation, they all had one common feature: they described in great detail the process of their medical treatment, hoping that they could be treated with heavy medication or new treatment methods. After careful further examination, she was told that it was not “pelvic inflammatory disease” at all, and that not only did she not need to treat “pelvic inflammatory disease”, but that she must immediately stop using antibiotics and stop all intra-vaginal and intestinal treatments, and that after a few months of recuperation, the pelvic and intestinal After a few months of recuperation, the pelvic and intestinal symptoms are “cured without drugs”. Therefore, the diagnosis of chronic pelvic inflammatory disease must be made with great care, and some unnecessary treatment after a rash diagnosis will not only fail to cure the patient’s symptoms, but also waste the patient’s money and even cause a burden on the patient’s mind.