Pelvic Inflammatory Disease - Page 161 Specific Women's Problems Section - Page 145 Pelvic Inflammatory Disease - Page 161 Pelvic Inflammatory Disease - Page 163

INFECTIONS OF THE CERVICAL BARRIER: The cervix is actually part of the uterus (the lower narrow end), so if a woman has an infection directly on the cervical barrier, this infection can work its way up along the lining of the uterus and into the fallopian tubes. Infections of the cervix are thought to be the most common cause of PID.

Certain bacteria like to grow in cervical tissue and are therefore more likely to pass into the reproductive organs. The most common of these bacteria are chlamydia and gonorrhea (these bacteria will not grow in the vagina). These bacteria are called "sexually transmitted" because they can be transferred from one partner to another during oral, anal, or vaginal sex; these bacteria can then attach to the woman's cervix causing a cervical infection. At this stage, when bacteria have infected the cervix only, the infection is easy to diagnose and treat effectively. A cervical infection which is diagnosed and treated promptly WILL NOT result in PID.

If chlamydia and gonorrhea are left untreated, they can move up into the reproductive organs and cause PID. It used to be believed that only a small proportion of cervical chlamydial or gonorrheal infections actually resulted in PID. Recent research has shown, however, that up to half of women with cervical chlamydial infections also have infection which has passed into the reproductive organs, even though most of these women did not have any symptoms of infection and therefore did not realize they had an infection.

Most women with cervical infections do not have any symptoms of infection, so unless the woman is especially careful to have regular checks for these bacteria, she may not realize she is infected, increasing the risk that the infection will spread into the reproductive organs. The lack of symptoms with chlamydial infections is deceptive because "silent" chlamydial infections cause as much or more damage as infections with more obvious symptoms.

Preventing cervical chlamydial and gonorrheal infections and treating cervical infections promptly BEFORE they progress to PID, are the MOST IMPORTANT STEPS IN PREVENTING PID.

SPERM: Although the cervix is designed to protect the reproductive organs from infection, it is also designed to let sperm pass through so that pregnancy can occur. Researchers have shown that bacteria can attach to sperm, and can then be carried by sperm through the cervix and into the reproductive organs, causing PID (the bacteria that are carried through the cervix on the man's sperm could be bacteria from the man, bacteria from the woman's cervix, or bacteria from the woman's vagina).

Barrier methods of birth control that kill or prevent sperm from crossing the cervix eliminate this risk factor. Women whose partners have had vasectomies rarely develop PID, probably because there is no sperm in the seminal fluid to carry bacteria across the cervix.

VAGINAL INFECTIONS: The cervix actually protrudes into a woman's vagina, so the cervix is in contact with any bacteria or other organisms that may be living there. A healthy woman's vagina usually has bacteria and yeast, living in a complex and balanced ecosystem. Sometimes the balance of the vaginal ecosystem is upset, and bacteria start to multiply quickly in large numbers. If this happens, the large numbers of bacteria may overwhelm the cervix's defences and enter the reproductive organs, causing an episode of PID.

It used to be thought that vaginal infections were not harmful, but recent research has shown that a common vaginal infection (bacterial vaginosis or non-specific vaginitis) can increase a woman's risk for PID especially following Cesarean Section or abortion. However, like cervical infections, vaginal infections are easy to diagnose, so women can reduce their risk by good vaginal health care and regular checkups.

INFECTION FROM SURGICAL OR MEDICAL PROCEDURES: Any surgical or medical procedure that involves touching the reproductive organs with instruments or foreign substances involves the risk of infection. Of course, sterilizing procedures are in place to prevent this, but despite precautions, infections sometimes occur. For example, cesarean section deliveries, which involve an abdominal incision, have a very high rate of pelvic infection (25 to 80 percent), unless an antibiotic is given to reduce this risk. Another procedure which occasionally causes infection is a hysterosalpingogram (a procedure to pass dye through the fallopian tubes to see if they are blocked or open). This is a relatively safe procedure which causes pelvic infection in less than one percent of women having this procedure. However, hysterosalpingograms are a common procedure, and women should be aware that the passage of the dye may introduce bacteria or spread bacteria from an already existing infection. The use of a preventive antibiotic can reduce the risk of this happening.

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