Pelvic inflammatory disease

Last updated: November 01, 2022

Pelvic inflammatory disease

Obgyn

Obgyn

Anatomy of the pelvic girdle
Anatomy of the pelvic cavity
Anatomy of the breast
Arteries and veins of the pelvis
Nerves and lymphatics of the pelvis
Anatomy of the female urogenital triangle
Anatomy clinical correlates: Breast
Mammary gland histology
Ovary histology
Fallopian tube and uterus histology
Cervix and vagina histology
Anatomy and physiology of the female reproductive system
Puberty and Tanner staging
Estrogen and progesterone
Menstrual cycle
Menopause
Pregnancy
Oxytocin and prolactin
Stages of labor
Breastfeeding
Precocious puberty
Delayed puberty
Klinefelter syndrome
Turner syndrome
Androgen insensitivity syndrome
5-alpha-reductase deficiency
Kallmann syndrome
Amenorrhea
Ovarian cyst
Premature ovarian failure
Polycystic ovary syndrome
Ovarian sex-cord stromal tumors
Ovarian surface epithelial tumors
Ovarian germ cell tumors
Uterine fibroid
Endometriosis
Endometritis
Endometrial hyperplasia
Endometrial cancer
Cervical cancer
Pelvic inflammatory disease
Breast cancer
Preeclampsia & eclampsia
Placenta previa
Placental abruption
Potter sequence
Postpartum hemorrhage
Congenital cytomegalovirus (NORD)
Miscarriage
Ectopic pregnancy
Fetal alcohol syndrome
Disorders of sex chromosomes: Pathology review
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Ovarian cysts and tumors: Pathology review
Cervical cancer: Pathology review
Vaginal and vulvar disorders: Pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Disorders of sexual development and sex hormones: Pathology review
Androgens and antiandrogens
PDE5 inhibitors
Adrenergic antagonists: Alpha blockers
Estrogens and antiestrogens
Progestins and antiprogestins
Aromatase inhibitors
Uterine stimulants and relaxants
Routine prenatal care: Clinical
Hypertensive disorders of pregnancy: Clinical
Antepartum hemorrhage: Clinical
Premature rupture of membranes: Clinical
Abnormal labor: Clinical
Vaginal versus cesarean delivery: Clinical
Postpartum hemorrhage: Clinical
Gestational trophoblastic disease: Clinical
Abdominal pain: Clinical
Amenorrhea: Clinical
Contraception: Clinical
Virilization: Clinical
Infertility: Clinical
Vulvovaginitis: Clinical
Sexually transmitted infections: Clinical
Abnormal uterine bleeding: Clinical
Ovarian cysts, cancer, and other adnexal masses: Clinical
Endometrial hyperplasia and cancer: Clinical
Cervical cancer: Clinical
Vaginal cancer: Clinical
Vulvar cancer: Clinical

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Pelvic inflammatory disease, or PID, is an infection of the upper female reproductive system, including the uterus, fallopian tubes, and ovaries.

It can cause a number of serious complications, including infertility.

The female reproductive system includes all of internal and external organs that help with reproduction.

The internal sex organs are the ovaries, which are the female gonads, the fallopian tubes, two muscular tubes that connect the ovaries to the uterus, and the uterus, which is the strong muscular sack that a fetus can develop in.

The neck of the uterus is called the cervix, and it protrudes into the vagina.

At the opening of the vagina are the external sex organs, and these are usually just called the genitals and they’re in the vulva region.

They include the labia, the clitoris, and the mons pubis.

The vagina, uterus, and fallopian tubes all have a mucosa, which is a layer of epithelial cells that lines the inside of these organs.

PID usually develops from a bacterial infection in the vagina or cervix which causes inflammation of this mucosal layer.

About 60 percent of the time, this changes the composition of the bacterial flora in the vagina, also called bacterial vaginosis.

Because the reproductive tract is essentially one long tunnel that starts at the ovaries and ends at the external sex organs, the infection can travel up the tract pretty easily.

Some mechanisms can make it even easier! For example, the cervical mucus, which normally acts as a barrier preventing bacteria from entering the uterus, may become less effective.

The mucus can become thinner as a result of normal variations throughout the menstrual cycle, or alternatively, it can become less effective in the context of bacterial vaginosis, which is when the normal balance of the vaginal flora is altered, and anaerobic bacteria proliferate and degrade the cervical mucus.

Other factors contributing to an infection may be retrograde menstruation, which is when menstrual blood flows back through the fallopian tubes and into the pelvic cavity instead of out of the body, and also sexual intercourse.

Now, PID is most problematic when the infection reaches the fallopian tubes, in which case it’s called salpingitis.

If it also affects the ovaries, it’s called salpingo-oophoritis.

The infection triggers a response from the body, which sends in neutrophils, plasma cells, and lymphocytes into the fallopian tubes. That sounds like a good thing, right?

But this actually damages the tubal epithelium and the tubes become filled with pus.

When scar tissue forms to repair the damage, areas with damaged epithelium tend to stick to one another, creating closed-off pockets and little dead-end pouches in the fallopian tubes.

This scarring in the fallopian tubes can lead to a number of complications related to PID.

If pus builds up in the tube and ovary, it can turn into an tubo-ovarian abscess, which can be life-threatening if it ruptures.

Key Takeaways

Pelvic inflammatory disease or PID is an infection of the upper female reproductive system that can affect the uterus, fallopian tubes, and ovaries. It is commonly caused by sexually transmitted infections (STIs) such as chlamydia and gonorrhea, but can also be caused by other types of bacteria.

Symptoms of PID include lower abdominal pain, pelvic pain, fever, abnormal vaginal discharge, and dyspareunia (pain during intercourse). However, some women may have no symptoms at all. If left untreated, PID can cause serious complications such as infertility, chronic pelvic pain, and ectopic pregnancy. Treatment involves a combination of antibiotics to clear the infection and anti-inflammatory medication to reduce pain and inflammation.

Sources

  1. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  2. "Robbins Basic Pathology" Elsevier (2017)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Pelvic Inflammatory Disease" Infectious Disease Clinics of North America (2013)
  6. "Pelvic Inflammatory Disease" New England Journal of Medicine (2015)
  7. "Microbiota and Pelvic Inflammatory Disease" Seminars in Reproductive Medicine (2014)