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Jill Weiss is the co-ordinator of the Canadian PID Society and has done extensive research in the area. She wrote this chapter to make sure women were informed about this important health issue.

Introduction

Pelvic inflammatory disease (PID) is a little known, but common illness that affects many women. Almost 100,000 Canadian women, and over one million women in the United States, contract PID each year. It is estimated that one in four North American women will have had PID by the year 2000. An episode of PID can have a significant impact on a woman's health. PID is the leading cause of preventable infertility and tubal pregnancy. Other long-term health problems and complications such as scarring and adhesion of the pelvic organs, chronic pain, tubal ovarian abscess, chronic infection, spread of infection to the liver capsule, spread of infection to the abdominal cavity and recurring infection are common after only one episode.

Although PID is a common and serious illness, there isn't a lot of public awareness about this disease. As a result, women often have difficulty getting information about treatment and prevention, and women who have PID often feel isolated and stigmatized.

What Is Pelvic Inflammatory Disease (pid) ?

Pelvic inflammatory disease (PID) is an infection or inflammation of a woman's reproductive organs (the uterus, fallopian tubes, ovaries and/or the surrounding tissue). Infection can sometimes spread to the abdominal cavity (called peritonitis), to the liver capsule (called perihepatitis), the appendix (periappendicitis), or the sigmoid colon (perisigmoiditis).

What Causes PID ?

A woman's reproductive organs are designed to be sterile. That is free of bacteria, viruses etc. A woman's body is specially designed to prevent bacteria from entering these organs. The uterus is shaped like a funnel, and the bottom narrow end of this funnel (the cervix) is usually closed and covered with a mucous that repels bacteria. This cervical "plug" usually prevents bacteria from passing into the reproductive organs.

However, sometimes bacteria can get past the cervix's defences and into the reproductive organs in the following ways.

OPENING OF THE CERVICAL BARRIER: If the cervix is opened, the protective barrier is lost, and vaginal or cervical bacteria can more easily pass into the reproductive organs. Any process or procedure which opens a woman's cervix and allows vaginal or cervical bacteria to pass into the reproductive organs can cause PID. Examples of medical procedures that open the cervix include D-and-C's, abortions, and insertion of IUD's. Women who have IUD's have about a twofold increased risk of developing PID and most of this increased risk is from the opening of the cervix to insert the IUD. Therapeutic abortions also increase the risk of PID because they involve opening the cervix. About three to 13 percent of women will develop PID after an abortion, although rates are higher if the woman already has an infection on her cervix or in her vagina.

Childbirth also opens the cervix and can result in PID. Sometimes pelvic infection after childbirth is called postpartum endometritis, because the infection often starts in the lining of the uterus. About two to five percent of women develop PID after childbirth, but rates are higher if the woman has a cervical or vaginal infection, if the membrane is ruptured for more than six hours, or if labour is prolonged. Women who have cesarean section deliveries have the highest risk of developing PID after childbirth. This is two to five times higher than with a vaginal delivery. (This may happen because the surgical procedure itself may introduce or carry bacteria into the reproductive organs.)