In many European and Scandinavian countries, laparoscopy is routinely given to any women who might possibly have PID. However, in Canada and in North America in general, laparoscopy is less frequently used.

NOTE: If a laparoscopy is performed, it is essential that cultures and samples of tissue be examined to check for infection and inflammation which may not be visible to the naked eye. Some pelvic infections do cause obvious signs of infection (pus, redness, inflammation) which can be easily seen through the laparoscope. However, many pelvic infections do not cause obvious redness or pus, and these infections will be missed if cultures and samples of tissue are not taken.

For example, a recent Canadian study by Toronto researcher, Dr. John Sellors, compared the results of laparoscopy using visual inspection alone to laparoscopy with cultures and examination of tissue samples under a microscope. This study found that when cultures and microscopic examination of tissue were not used during laparoscopy, about half of pelvic infections were missed. This is an important study, because in Canada, laparoscopies are often performed without cultures or samples of tissue being taken, thus not diagnosing about half of pelvic infections.

Promptness Of Diagnosis And Treatment

A woman who suspects she has PID should try to obtain diagnosis and treatment immediately. Although PID is difficult to diagnose, prompt and accurate diagnosis is very important, because treatment is less effective if it is delayed. Even a short delay can be serious. One study found that most women treated within two days recovered completely, while women whose treatment was delayed for one week had many more serious consequences such as infertility and ectopic pregnancy. For this reason, it is recommended that whatever diagnostic strategy is chosen, treatment must not be delayed due to an uncertain diagnosis.

Symptoms Of PID

It is important to keep in mind that there is no typical pattern of symptoms for PID. In fact, studies have shown that less than five percent of women with PID appear severely ill, and less than 16 percent have three or more of what used to be considered the "typical symptoms" of PID. In fact, most women with PID have only one or two symptoms, and often these are mild. Some women with PID have no symptoms at all. This is called "Silent PID" and is now believed to be far more common than previously thought, especially when chlamydia is involved.

In addition, research has shown that there is no correlation between the severity of a woman's symptoms and the actual severity of pelvic infection. Women who have mild or no symptoms are just as likely to have damage to their reproductive organs as women with more obvious symptoms.

Keeping this in mind, the symptoms of PID are:

• Abdominal pain is the most common and often the only symptom. The pain can be mild or severe, occasional or constant. Often the pain is very mild, especially if chlamydia has caused the infection.

• A feeling of fullness, bloating or pressure in the abdomen.

• Deep pain during intercourse.

• Abnormal periods or bleeding between periods.

• Unusual discharge from the cervix or vagina.

• Fever or chills.

• A general feeling of illness or tiredness.

• Nausea.

• Lower back pain.

• Urination that is painful or more frequent than usual.

• If a woman has infection which has spread to the liver capsule (perihepatitis), she may also experience pain in the upper right side (near the lungs). This pain is usually, but not always, combined with lower abdominal pain. The pain may be made worse by movement, deep breathing or coughing and may be referred to the shoulder or arm.