One ectopic pregnancy occurs in every 100 pregnancies and a 2005 statistic shows that the incidence of ectopic pregnancy in women worldwide has increased 3 to 5 times in the last 3 years compared to 20 years at the end of the last century and has become a global health problem. The various causes of ectopic pregnancy have been studied, and tubal adhesions and scarring due to pelvic inflammatory disease are the first causative factors of ectopic pregnancy.
Avoiding ectopic pregnancy should start with avoiding pelvic inflammatory disease. Here is a summary of the CDC’s description of pelvic inflammatory disease
What is pelvic inflammatory disease?
Pelvic inflammatory disease, referred to as pelvic inflammatory disease, is a syndrome of infection of the uterus, ovaries and fallopian tubes and adjacent tissue structures of the pelvis, resulting in a range of clinical symptoms including lower abdominal pain, and is a common gynecologic condition. Pelvic inflammatory disease is a serious comorbidity of sexually transmitted diseases, especially infections with two major groups of pathogens, gonococcus and chlamydia. Pelvic inflammatory disease seriously affects women’s health because it damages the fallopian tubes and nearby uterine and ovarian tissues, leading to infertility, ectopic pregnancy, pelvic abscesses, and chronic small abdominal pain as sequelae.
In the United States, it is estimated that there are more than 750,000 cases of acute pelvic inflammatory disease each year, of which 10-15% may result in infertility, and the majority of ectopic pregnancies in emergency rooms are also sequelae of pelvic inflammatory disease.
How do women develop pelvic inflammatory disease?
The greater the number of sexual partners a woman has, the higher her risk of developing pelvic inflammatory disease. Likewise, sexual partners who have more than one sexual partner will already put themselves at risk for the disease, as all of the above factors clearly increase a woman’s exposure to various sources of infection. This is why sexually active people and women of childbearing age are at high risk, while virgins and older women who have hardly had sex after menopause are rarely affected.
Most of the pathogenic bacteria enter the uterus and fallopian tubes through the vagina or cervix, eventually leading to pelvic infections. Many pathogenic bacteria are responsible for the disease. The two most common types of pathogens are gonococcus and chlamydia, which are the two most common types of pathogens that cause sexually transmitted diseases.
Sexually active women are the most at risk throughout their reproductive years, and women under 25 years of age are at higher risk than women over 25 years of age because the cervical development of teenage women is still incomplete and the local immunity and resistance of the reproductive tract is not yet sound, making them more sensitive to STI pathogens and more susceptible to disease.
Women who perform daily vaginal douching are more likely to develop pelvic inflammatory disease. Studies have found that vaginal douching alters the settlement of normal vaginal flora and can easily flush pathogenic bacteria into the cervix and uterine cavity, leading to upstream infections. A healthy woman’s vagina is self-cleaning and women should not assume that douching with water or commercially available lotions will make them cleaner and healthier.
Compared to women taking oral contraceptives or no contraception at all, the placement of an IUD (IUD) may mildly increase the risk of pelvic inflammatory infections in the near future. However, this risk is greatly reduced if women are screened and treated for sexually transmitted infections prior to IUD insertion. Therefore, the World Health Organization recommends IUD insertion only for women who are not at risk for STIs and cautions that women who have had an episode of pelvic inflammatory disease in the past three months should use the IUD with caution.
What are the symptoms of pelvic inflammatory disease?
Symptoms of pelvic inflammatory disease vary widely and can be very mild or can manifest as severe abdominal pain, high fever or even infectious shock. A tubal infection caused by chlamydia can be unsuspected, or even very serious damage can occur without the woman noticing it. Because the symptoms are mild, pelvic inflammatory disease is usually ignored by patients and doctors until infertility testing is performed and it is discovered that the tubes are severely damaged bilaterally and no longer functional, leaving in vitro fertilization as the only option. Most patients with pelvic inflammatory disease will have symptoms of lower abdominal pain, as well as fever, abnormal purulent leucorrhea with foul odor, painful intercourse, painful urination, and irregular vaginal bleeding.
What are the sequelae of pelvic inflammatory disease?
Prompt and effective treatment can effectively reduce the occurrence of sequelae, especially permanent and irreparable damage to the reproductive system. We know that the fallopian tubes are the cave of sperm and egg, where they meet and unite before moving back to the uterus to settle and slowly grow and develop into a healthy baby. Pathogenic bacteria often sneak up on the fallopian tubes, causing scarring of the normal tissue. Scarified tissue interferes with the movement of the fertilized egg from the fallopian tube to the uterus, increasing the risk of ectopic pregnancy.
If the fallopian tubes are completely destroyed, sperm and eggs will not be able to meet, leading to complete infertility. At least 10-15% of women with pelvic inflammatory disease develop infertility, and the risk of infertility increases exponentially with recurrent episodes of pelvic inflammatory disease.
Adhesions and scarring of the fallopian tubes and other pelvic tissues will also lead to chronic pelvic pain, which often lasts for months or even years and can seriously affect a woman’s physical and mental health.
How is pelvic inflammatory disease diagnosed?
Because the symptoms of pelvic inflammatory disease are atypical and sometimes even mild, many patients miss the diagnosis. There are no specific and precise tests to diagnose pelvic inflammatory disease. if there are symptoms of lower abdominal pain, the doctor will perform a gynecological examination and test vaginal and cervical secretions for evidence of infection such as gonococcus or chlamydia. once a diagnosis of pelvic inflammatory disease is suspected, treatment should be provided as soon as possible. ultrasound helps to detect any enlargement of the fallopian tubes or accumulation of pus, and sometimes laparoscopy is required.
How to treat pelvic inflammatory disease?
Once a woman has uncomfortable symptoms such as lower abdominal pain, fever and purulent leucorrhea, she should consult a doctor as soon as possible. The correct choice of antibiotics with the help of a doctor can cure pelvic inflammatory disease. Once the inflammation causes damage to the fallopian tubes and other important tissues, such as twisted adhesions or scarring atresia of the fallopian tubes, antibiotics will not be able to reverse it. Therefore, early diagnosis and timely treatment are especially critical and important. The longer the delay in treatment, the higher the risk of infertility or ectopic pregnancy due to permanent damage to the fallopian tubes.
Some severe cases require hospitalization for.
(1) Poor general condition, such as nausea, vomiting, high fever.
(2) Pelvic inflammatory disease in pregnant women.
(3) ineffective oral medication requiring intravenous antibiotic infusion.
(4) Tubal abscess or tubo-ovarian abscess formation.
(5) Need for close observation, except for acute appendicitis or other diseases requiring surgical treatment.
(6) Surgical treatment is also required if the symptoms of pelvic inflammatory disease persist or if the abscess does not subside with the available treatment and there are severe signs of infectious toxicity.
Once pelvic inflammatory disease turns into chronic pelvic pain, adhesions and scarring lesions are difficult to treat and sometimes it may be helpful to resort to surgical procedures.
How can I prevent pelvic inflammatory disease?
Women can best avoid pelvic inflammatory disease by recognizing the disease and protecting themselves from sexually transmitted infections. Once you have contracted a sexually transmitted infection, be sure to seek medical attention and begin treatment as soon as possible. The surest and most accurate way to avoid sexually transmitted diseases is to abstain from sex, or to stay in a one-on-one sexual partnership with a healthy and safe man for a long period of time. Long-term and proper condom use can effectively reduce the risk of chlamydia and gonococcal infections.
The CDC recommends annual chlamydia testing for the following groups.
(1) All sexually active women 25 years of age or younger.
(2) Women over 25 years of age but at risk for chlamydia (e.g., have a new sexual partner, or have multiple sexual partners).
(3) All pregnant women.
Any discomfort in the genital tract, such as unusual pain, foul smelling leucorrhea, burning sensation during urination, irregular bleeding between menstrual periods, may be a sign of an STI and if a woman has these symptoms, she should stop sexual activity and seek medical attention as soon as possible.
Women who are fertile and sexually active need to acquire the basic knowledge mentioned above, know the importance of maintaining a stable partnership, use condoms correctly to protect themselves from sexually transmitted diseases, recognize the common symptoms of pelvic inflammatory disease mentioned above, so that if their resistance decreases and they happen to be attacked by germs, they can recognize the symptoms in time, seek medical attention early and treat them as soon as possible without leaving any sequelae, and live a healthy life on their own.