Infections

Pelvic Infammatory Disease

PID or Pelvic Inflammatory disease that is caused by bacterial infection in the upper female genital tract. There are 3 main ways that an infection can occur:

  1. From the lower genital tract to the upper: This is the most common route of PID, mostly from sexually transmitted bacterias such as gonorrhea and chlamydia, but also from gynecological procedures such as insertion of IUD, D&C, abortion and endometrial biopsy.
  2. From infection of surrounding organs: Infection of the bladder, appendix or other surrounding organs can also lead to Pelvic Inflammatory Disease. Ureaplasma urealyticum is often a cause in chronic bladder infections and is also a factor in some PID cases.
  3. From transfer of bacteria through the circulatory or lymphatic system: Bacteria from the respiratory system such as pneumonia can travel through the body and cause PID.

Depending on where the inflammation is present in the upper female genital tract, it will have a specific name.

  • Endometritis: Inflammation and infection of the endometrium (lining of the uterus)
  • Salpingitis: Inflammation and infection of the fallopian tubes
  • Oophoritis: Inflammation and infection of the ovaries
  • Pelvic peritonitis: Inflammation and infection of the membrane that lines the pelvic cavity
  • Inflammation of the pelvic connective tissues

Pelvic Inflammatory Disease affects almost one million each year (in the United States alone)

Pelvic Inflammatory Disease is the most serious complication of sexually transmitted diseases for women, it is a major cause of infertility and ectopic pregnancy.

How Chinese Medicine Treats Pelvic Inflammatory Disease

PID progresses rapidly, improper treatment  can result in permanent damage to the upper genital tract and chronic PID. Diligent and timely treatment are needed to gain progress in treating this disease.

For more severe acute infections or stubborn chronic infections, an integrated approach is recommended using antibiotics and herbal medicine.  Treatment with herbal medicine is essential, as bacterial infections, especially gonorrhea are becoming increasingly resistant to antibiotics. Bacteria do not become resistant to herbal medicine in this way and have powerful antibiotic properties themselves.  Treatment with antibiotics and herbal medicine together can shorten the time needed with antibiotics.

Mild acute infections may be treated with herbal medicine, compresses and soaks without the use of antibiotics and may take around 1 month of treatment.

In Chinese Medicine, this condition is related to damp-heat settling in the reproductive system which can be comparable to inflammation in the reproductive system. Other factors involved are blood and Qi (energy) stasis.

Chinese Medicine has many treatment techniques to combat PID, we recommend using a combination of herbal medicine.

Herbals used include ones with strong antibiotic properties which do not damage the beneficial flora of the body as well as herbs to strengthen the body’s energy and immune functions to combat the infection (herbs to clear damp-heat, qi tonics and herbs to improve circulation).  Herbs are used in different ways to maximize the effectiveness, they are taken internally in a tea-this is called a decoction.  They are boiled and added to a bath- this is a hip bath and allows the herbs to soak into the tissues. They are used in an enema-this gets the herbs very close to the affected area for treatment. They are used in a compress- similar to the hip bath effect- the herb properties affect the reproductive system from the outside to the internal reproductive system.

Acupuncture is shown to increase antibodies in the blood which fight infection within about half hour of receiving the treatment.

Use of a heat lamp improves micro-circulation and stimulates healing of tissues.

When TCM can help:

  • Acute or sudden PID infections
  • Chronic PID infections
  • Regardless of the type of bacteria that is the cause of the infection

Both partners need to be treated for STD related PID or reinfection will occur.

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About: Sexually transmitted bacteria Chlamydia trachomatis which easily passes through the cervix to cause PID.It is the most common sexually transmitted disease world wide. It is known as the silent epidemic, it doesn’t cause syptoms in 70%-80% of cases.

Symptoms: Mostly asymptomatic. Other signs inclue unusual vaginal bleeding or discharge, pain in the abdomen, pain on intercourse, fever, painful urination or the urge to urinate more frequently than usual (urinary urgency).

Transmission:  Vaginal, anal and oral sex.

Gynecology complications: Chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy.

About: Sexually transmitted bacteria Neisseria gonorrhoeae​ which easily passes through the cervix to cause PID. It is increasingly resistant to antibiotics.

Symptoms:  Also commonly asymptomatic in females. Other signs include vaginal discharge, lower abdominal pain or pain on intercourse.

Transmission: Vaginal, anal and oral sex.

Gynecology complications: Chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy. One of the complications of gonorrhea is systemic dissemination resulting in skin pustules or petechia, septic arthritis, meningitis or endocarditis.

About: Small bacterium which lives in the genital and respiratory tract. Responsible for an increasing amount of PID infections.

Symptoms: Vaginal discharge, burning urination, vaginal itching, pain during intercourse.

Transmission: Vaginal, anal and oral sex.

Gynecology complications: Urethritis, bacterial vaginosis, chronic pelvic pain, ectopic pregnancy and one form of arthritis.

About: A natually occuring bacteria which is present in about 70% of sexually active people. Although not a sexually transmitted diseae, this bacteria can become too abundant and pass the cervix to cause PID.

Symptoms: A continual dull ache or pain around the genitals, burning or pain when urinating. Ureaplasma has been associated with a number of diseases such as non-specific urethritis (NSU)

Transmission: Unknown, but the risk of infection rises with more sexual partners.

Gynecology complications:  Non-specific urethritis (NSU), infertility, chorioamnionitis, stillbirth, premature birth, and, in the perinatal period, pneumonia, bronchopulmonary dysplasia and meningitis.

Diagnosis

There are wide variation of possible symptoms and signs which makes the diagnosis difficult, especially since many women have mild or even no signs. Below are some possible signs that may indicate Pelvic Inflammatory Disease.

Physical indications:

  • Genitourinary tract symptoms: Lower abdominal pain, excessive vaginal discharge, menorrhagia (heavy and long period), metrorrhagia (bleeding between periods), fever, chills, nausea/vomiting and urinary symptoms.
  • Pelvic organ tenderness: Uterine tenderness alone or with ovary/fallopian tube tenderness.

Testing done by the laboratory which can confirm Pid:

  • Evaluation of vaginal secretions
  • Endometrial biopsy
  • Ultrasound
  • Laprascopy

Risk Factors for Contracting Pelvic Inflammatory Disease:

  • People with new sexual partners
  • People with more than 2 partners
  • People not using any method of protection
  • Individuals abusing drugs or alcohol before engaging in sexual intercourse
  • Women who use IUDs
  • Women who do not get regularly tested for STDs
  • Women who do not have annual check-ups / pap smears
  • Women under the age of 25
  • Women who douche regularly
  • Women within 12 months of post partum care

Discussion on PID and Infertility

It is the scarring as the result of a long lasting or severe pelvic inflammatory infection that can lead to infertility. Scarring can occur in the fallopian tubes where the fertilization process is supposed to occur, the ovaries or the uterus. The CDC estimates that infertility will affect 10-15% (1 out of 10 women) of women with PID.

A study at the John Hopkins Children’s Centre showed that reoccurring pelvic inflammatory infections doubles the chance of infertility. Reoccurring infections can also quadruple the risk of chronic pelvic pain.

In the case of tubal blockage from scarring, Chinese Medicine does have effective treatments, but they are currently not being performed in North America. Currently, in the case of infertility due to tubal blockage, assisted reproduction is the better choice.