Chronic Pain is the Most Common Cause of Pelvic Inflammatory Disease

Pelvic inflammatory disease is a serious infection affecting the uterus, fallopian tubes, and/or ovaries. It primarily affects women between the ages of 15 and 25. The infection develops through an ascending path from the vagina to the reproductive organs. Bacteria from untreated sexually transmitted infections are the most common cause of pelvic inflammatory disease.

Severe pelvic inflammatory disease can lead to permanent damage to the reproductive organs and result in infertility. Testing and treatment for sexually transmitted infections are the best ways to prevent pelvic inflammatory disease.

Every year, more than 1 million women in Europe suffer from pelvic inflammatory disease, and over 100,000 of them become infertile as a result.

Symptoms of the condition can be mild or unnoticed, but they can also start suddenly and include:

1. Pain or tenderness in the stomach or lower abdomen is the most common symptom.
2. Unusual vaginal discharge, usually yellow or green in color with an unpleasant odor.
3. Chills or fever.
4. Nausea and vomiting.
5. Pain during sexual intercourse.
6. Urinary disturbances.
7. Irregular menstrual periods or spotting, or spasms throughout the month.

Pain from pelvic inflammatory disease is mainly felt in the lower abdomen or pelvic region. It may feel like a dull, constant pain and can be felt deep in the pelvis during intercourse.

Bacteria entering the reproductive tract cause pelvic inflammation. These bacteria pass from the vagina through the cervix and upward into the uterus, fallopian tubes, and ovaries. Usually, when bacteria enter the vagina, the cervix protects against their spread deeper into other reproductive organs. However, any type of infection can compromise the protective barrier of the cervix.

Many types of bacteria can cause pelvic inflammatory disease, but the two most common infections leading to the condition are gonorrhea and chlamydia. Both infections are transmitted through unprotected sexual intercourse and account for about 90% of all cases of pelvic inflammatory disease.

Less commonly, the disease develops when normal bacteria inhabiting the vagina ascend into the reproductive organs through an ascending path. This can occur after:

1. Childbirth.
2. Surgical intervention in the pelvic area.
3. Abortion.
4. Placement of intrauterine devices. The risk is highest within a few weeks after insertion.

It may take from a few days to several weeks for the disease to develop if the cause is an untreated infection with gonorrhea or chlamydia.

Some women are at a higher risk of developing pelvic inflammatory disease if they:

1. Have a history of sexually transmitted infections, especially gonorrhea or chlamydia.
2. Have a history of multiple sexual partners.
3. Have a history of past pelvic inflammatory disease.

The longer a reproductive organ infection remains untreated, the more serious the complications can become. The infection can lead to the formation of connective tissue in the fallopian tubes. Scars can cause several problems, including:

1. Chronic pelvic pain – long-lasting pelvic pain is the most common complication. One study estimates that about 20% of women develop chronic pelvic pain.
2. Ectopic pregnancy – scars may prevent the fertilized egg from being transported to the uterus. This can lead to implantation in the fallopian tubes. The rate of ectopic pregnancy in women with pelvic inflammatory disease is much higher.
3. Infertility – Up to 10% of women with pelvic inflammatory disease lose their ability to conceive due to blocked fallopian tubes and the prevention of egg release from the ovaries.
4. Tubo-ovarian abscess, representing a pocket of infection in the pelvis, which can be life-threatening.