Introduction
Pelvic Inflammatory Disease is an infection of the genital tract and reproductive organs in women. It most often occurs when the causative organism, mostly bacteria spread from the vagina to the uterus, fallopian tubes or ovaries. This infection may happen naturally or it can be sexually transmitted. PID is most common in sexually active women in their reproductive age.
PID is the leading cause of infertility for women in the United States. The signs and symptoms of pelvic inflammatory disease can be subtle or mild. Some women don’t experience any signs or symptoms. As a result, many women might not realize they have it until having trouble getting pregnant or until the development of a dull & chronic pelvic pain. Symptoms may also be confused with conditions like appendicitis, ectopic pregnancy, or ovarian cysts. It can be diagnosed during a pelvic exam or through pelvic ultrasound or laparoscopy. Treatment involves antibiotics and antimicrobial agents. More than one cycle of treatment will be needed to clear PID completely in many women.
Signs & Symptoms
Signs and symptoms may be subtle or mild. Some women will not have any symptom at all. When signs and symptoms of PID are present, they most often include:
- Pain (mild to severe) in the lower abdomen and hip
- Abnormal or heavy vaginal discharge that may have an unpleasant smell
- Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
- Pain during intercourse
- Fever, sometimes with chills
- Painful, frequent or difficult urination
Causes
Most common cause is infection from a bacterium like Gonorrhoea or Chlamydia
Risk factors
Being a sexually active woman younger than 25 years old
Having multiple sexual partners
Being in a sexual relationship with a person who has more than one sex partner
Having sex without a condom
Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms
Having a history of pelvic inflammatory disease or a sexually transmitted infection
After the insertion of an intrauterine device (IUD). This risk is generally confined to the first three weeks after insertion.
Pathophysiology
Most cases of PID are presumed to occur in 2 stages. The first stage is acquisition of a vaginal or cervical infection. This infection is often sexually transmitted and may be asymptomatic. The second stage is direct ascent of microorganisms from the vagina or cervix to the upper genital tract, with infection and inflammation of these structures.
The mechanism (or mechanisms) by which microorganisms ascend from the lower genital tract is unclear. Studies suggest that multiple factors may be involved. Although cervical mucus provides a functional barrier against upward spread, the efficacy of this barrier may be decreased by vaginal inflammation and by hormonal changes that occur during ovulation and menstruation.
In addition, antibiotic treatment of sexually transmitted infections can disrupt the balance of endogenous flora in the lower genital tract, causing normally non-pathogenic organisms to overgrow and ascend. Opening of the cervix during menstruation, along with retrograde menstrual flow, may also facilitate ascent of microorganisms.
Intercourse may contribute to the ascent of infection through rhythmic uterine contractions occurring during orgasm. Bacteria may also be carried along with sperm into the uterus and fallopian tubes.
In the upper genital tract, a number of microbial and host factors appear to influence the degree of inflammation that occurs and, thus, the amount of subsequent scarring that develops. Infection of the fallopian tubes initially affects the mucosa, but inflammation may rapidly become transmural. This inflammation, which appears to be mediated by complement, may increase in intensity with subsequent infections.
Inflammation may extend to uninfected parametrial structures, including the bowel. Infection may extend via spillage of purulent materials from the fallopian tubes or via lymphatic spread beyond the pelvis to produce acute peritonitis and acute perihepatitis (Fitz-Hugh−Curtis syndrome).
Diagnosis
No single test can accurately diagnose pelvic inflammatory disease. Instead, a any of the following methods will be used:
- medical history including sexual habits
- Signs and symptoms
- A pelvic examination
- Blood and urine tests
- Ultrasound
- Vaginal swab tests or pap smear tests
- Endometrial biopsy.
Treatments
Proper treatment with medicine can get rid of the infection that causes pelvic inflammatory disease. Any scarring or damage to the reproductive tract due to PID can’t be reversed. Treatment for PID most often includes:
- Treatment for partner is also important as it can be sexually transmitted.
- Temporary abstinence.
- Surgery is rarely needed, such as in cases of a ruptured abscess.
Prognosis
Prognosis is good in acute cases, but approximately 25% of patients diagnosed with acute PID develop long-term sequelae. The risk for sequelae is increased if the patient has recurrent episodes of PID. Tubal factor infertility (TFI) – TFI occurs in approximately 8-19% of women after one episode of PID
Complications
Scar tissue and pockets of infected fluid (abscesses) developed in the reproductive tract. These can cause permanent damage to the reproductive organs.
Complications from this damage might include:
- Ectopic pregnancy.
- Chronic pelvic pain.
- Tubal or ovarian abscess
Disease & Ayurveda
Diseases of female genital tract are described under the heading Yonirogas. Manifested cases of PID can be compared with features described under Paripluta yoniroga.
Nidana
Holding of sneezing and belching during coitus (by woman with Pitta constitution or Pitta dominance
Purvaaroopa
Not mentioned
Samprapti
When a woman with Pitta dominance indulges in coitus holding the urge for sneezing and belching, the Vaata along with Pitta get vitiated, reach her vagina and produce the disease.
Lakshana
Swelling/inflammation in the vagina
Tenderness in vagina
Painful bleeding with yellow or bluish tinged discharge
Severe pain in the hip, inguinal area, and lower back
Fever
Divisions
Not mentioned
Prognosis
Kashtasadhya
Chikithsa
Ayurvedic treatment of Paripluta is managing the imbalanced Pitta and Vaata considering not to vitiate Kapha. Therapies are needed to reduce inflammation and to bring normalcy of all the three doshas locally and in the whole body. Wholesome diet and regimens along with proper dinacharya & ritucharya are also advised for complete cure.
Samana
After proper aamapaachana & agnideepana, santarpana (nutritive diet) is advised. Lepanam with sothahara dravyas
Parisheka with thriphala/naalpamara kwatha
Swedanam
Yonipichu – tampoons with medicated oils
Sodhana
Virechana
Kashayavasti
Snehavasti
Uttaravasti
Commonly used medicines
Sukumaram Kashayam
Guggulupanchapalachoornam
Kanchanaraguggulu
Saptasaram kashayam
Guduchyadi kashaym
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Practice safe sex. Use protective measures/physical barriers.
Use safe methods of contraception.
Get regular screening tests if you are prone to PID
Avoid douche.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil, cow’s ghee
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Maintain proper personal hygiene, especially private parts.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843151/
https://pubmed.ncbi.nlm.nih.gov/12179634/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
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