Can PID (Pelvic Inflammatory Disease) Occur Without a Partner Bringing an STD?

A woman recently asked me whether PID can occur from causes other than their partners bringing an STD to them.

The answer is, yes, it is absolutely possible to get PID without our sexual partners cheating and bringing an STD to us.

But, it is true that, many times, PID can be caused from our partners giving us Chlamydia or gonorrhea. If this goes undetected and untreated it can become a super infection called PID and move into our uterus, tubes, ovaries, abdomen and pelvis.

If couples have oral sex this can even put women at risk for Chlamydia or gonorrhea pneumonia or meningitis. The same is true for couples that have anal intercourse and may be transferring bacteria from the anal area to the vaginal region. This is why using WaterWorks immediately after sex can really help avoid these types of infections by helping us clear out the semen and abnormal bacteria.

Women may often show positive blood cultures for bacteria. Because there are many strains of bacteria naturally in the vagina, and if a woman has even a slight shift of the bacterial flora causing a leaning towards bacterial vaginosis, these abnormal bacteria can cause PID.

This is a serious illness that usually requires hospitalization for IV antibiotics. Women can become so sick that they can experience fevers, chills, vomiting, vaginal bleeding and discharge.

Remember, unless your PID was definitely caused by Chlamydia or gonorrhea, which would show up on the cultures that were done, then he may not have cheated on you. Okay?

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Bacterial Vaginosis

Did you know that having bacterial vaginosis can increase your risk for STD's, HIV and pregnancy complications like preterm labor?

Bacterial vaginosis is a type of vaginal inflammation that results from the OVERGROWTH of one of several types of bacteria normally present in the vagina, upsetting the natural balance of vaginal bacteria. Lactobacilli is the predominant bacteria that colonizes the vagina. It is also the predominant bacteria in yogurt culture. That is where all the yogurt remedies come from. Some of us have been told if we eat more yogurt it will heal the vagina. But, while yogurt is a form of pro-biotic, and eating it will certainly heal your GI tract and colon, our GI tract is not connected to our vagina.

Women in their reproductive years are most commonly affected by bacterial vaginosis, but any woman can experience the condition. We don't know exactly why bacterial vaginosis develops, but certain activities, such as unprotected sexual intercourse, multiple partners or frequent douching, put you at higher risk of the condition.

Anything that creates an imbalance or flips the growth of the vaginal flora (causing the non-dominant bacteria to become dominant and over grow), will reduce the lactobacilli. Then we begin to notice the "fishy" or "musty" odors and increased discharge that won't go away despite repeated showers and cleaning of the area.

You know from my previous postings that douching is one of the worst practices we can be taught and pass on to young women. Why? The vagina is designed to self-clean and has a delicate balance and it must maintain a lower, slightly acidic pH. If this balance becomes disrupted and the pH rises to a neutral or alkaline pH, the lactobacilli die off and the other bacteria and yeast begin to overgrow. That's when we start noticing odor and irritation. If we continue to douche thinking this will help, it will just keep this cycle going and going.

Generally, it's not necessary to treat a woman's male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and, if indicated, treatment of bacterial vaginosis.

I know some of you struggle with recurring vaginal odor, external irritation and daily discharge. Just when you have finished taking a prescribed treatment, and have been odor- and irritation-free for a few days, you notice it start to creep back…and the whole cycle starts over again. Let me reassure you that this is not because you have poor hygiene or are not clean enough. In fact, some of you try too hard and actually over-clean, which can upset the way your vagina heals and self-cleans -- actually making it worse

Some of the most common causes of vaginal odor are:

• The alkaline semen from sex
• Period blood
• Infections like Trichamonas, Chlamydia, Gonorrhea and Pelvic Inflammatory Disease
• Poor hygiene and retained or forgotten tampons

Less common causes of vaginal odor are:

• Cervical, vaginal or other female cancers
• A recto-vaginal fistula - a defect that forms between the rectum and vagina that can allow liquid feces or urine to drain through the vagina. These tunnel-like communications usually do not form spontaneously but may show up after surgery like a hysterectomy or vaginal repair, or vaginal childbirth that resulted in an episiotomy or vaginal tear.
• A condition known as Crone's disease of the colon

So hang in there. Sometimes not douching and treating back-to-back with the correct medication will help you rebalance and keep you free of infection for longer periods of time.

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Why Do I Still Suffer With So Much Pelvic Pain & Pain With Sex? I Have Already Had So Many Surgeries & Been On Several Medications.

Some causes of chronic pelvic pain like endometriosis show up at an early age, possibly a few years after onset of menstruation, and continue through childbearing and up to menopause with worsening symptoms as time goes on.  Endometriosis is always cyclical in the beginning, meaning the pain shows up with periods, and the rest of the month there is little or no pain.  As it progresses, causing more scarring to the internal genitalia, the pain may worsen and bring fevers, nausea, and dysparunea (painful sex).  Endometriosis is easily diagnosed.

     

Pelvic pain can also be due to anatomic or pathological abnormalities like ovarian cysts, uterine fibroids, an enlarged uterus, chronic yeast or other infections, interstitial cystitis, diverticulitis or IBS, retroverted uterus and adhesions from previous surgeries or infections.  Of course, there are more that are not mentioned, including pelvic nerve disorders and discomfort related to other pain syndromes.

            

One common cause of pelvic pain is Pelvic Congestion Syndrome, a pelvic pain disorder often overlooked or misdiagnosed as endometriosis.  It is thought to be caused by varicose veins in the pelvis, and just like varicosities in the legs or any part of the body, this interferes with circulation and can block inflow and outflow to the pelvis - creating pain, irregular bleeding and many other problems.  Pelvic Congestion is most commonly seen in women between the ages of 20-45 who have had multiple pregnancies.  

The exact cause of Pelvic Congestion Syndrome is unknown, though it is thought that these changes could contribute:

• Physiological: In pregnancy there is a significant increase in fluid, and weight gain is common. It is believed that this excess fluid and weight gain disrupts the veins and causes them to engorge with blood. Over time, the veins become distended and the condition progresses because the valves have been destroyed.

• Estrogen: It is known that estrogens can weaken the vein walls and during pregnancy the increase in estrogens may play a role in the development of varicose veins, which is a common occurrence. Perhaps that is why men do not develop this syndrome.

• Anatomical: Others believe that there may be some anatomical changes in the anatomy of the veins and other structures in the pelvis that may make them more susceptible to formation of varicose veins.

Pelvic venous congestion syndrome is very similar to the condition of varicose veins seen in the legs. In both cases, the valves in the veins that help blood flow toward the heart are either defective or damaged. The function of the valves is to prevent back flow of blood. When the valves are destroyed, pooling of the blood occurs in the veins. The veins become engorged with blood and get bigger, stretching the vein wall.  The enlarged veins can occur near the uterus, fallopian tubes, vulva and even the vagina. The condition can worsen with weight during pregnancy.

   

Pain of varying severity is the most common complaint. The pain is typically dull and not associated with menstruation.  But it can worsen:

• Just before the onset of the menstrual cycle, like endometriosis

• At the end of the day

• After prolonged standing

• During or just after intercourse

• During later stages of pregnancy

The other commonly associated symptoms can include some of the following, and can add to the discomfort and pain.

• Swollen vulva/vagina

• Varicose veins (vulvar, buttocks, legs)

• Abnormal menstrual bleeding

• Tenderness to touch in lower abdomen

• Pain during intercourse

• Painful menstrual periods

• Backache

• Vaginal discharge

• General lethargy

• Feelings of depression

Ultrasound, CT scan or MRI may be used in the diagnosis.  Early treatment options include pain medication, ovarian suppression and alternative therapies such as acupressure and physical therapy.  The surgical option involves stopping blood flow to the varicose veins using noninvasive techniques such as a procedure called embolization.

Medications (ergotamine) that narrowed the veins were tried and hormones were also prescribed, but neither helps.  Prescription pain medications and antidepressants often used for chronic pain work great.  Many 'natural' or alternative treatments bring a lot of  help and many women turn to physical therapy, transcutaneous electrical nerve stimulation, behavior and psychological counseling, trigger point injections, epidural and spinal nerve blocks and acupuncture.

    

Pelvic Congestion Syndrome is a difficult disorder both in terms of diagnosis and treatment. The vague symptoms and variable intensity of pain do not all respond to one treatment. All types of treatments have been recommended and currently, embolization is the preferred therapy. However, before one embarks on any therapy, read and understand the disorder and talk with a reputable physician or radiologist.

     

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