PT Health Watch: How pelvic inflammatory disease threatens fertility in women

Pelvic Inflammatory Disease (PID) is a serious infection that can affect a woman’s reproductive health, often leading to complications such as infertility, chronic pelvic pain, and ectopic pregnancies.

It affects reproductive organs, including the uterus, fallopian tubes, and ovaries. It primarily results from untreated sexually transmitted infections (STIs) such as chlamydia and gonorrhoea.

According to an expert, Tinu Gani, a gynaecologist, when PID is left untreated, the infection can cause significant damage to the reproductive system through fibrosis and cilia destruction.

Globally, studies have shown that the prevalence rate of PID was approximately 53.19 per 100,000 population in 2019, with overall prevalence figures ranging from 0.28 per cent to 1.67 per cent, depending on the population studied. 

In Nigeria, the situation is even more concerning. Research indicates that prevalence rates can vary widely, with hospital-based studies reporting figures ranging from 11 per cent to as high as 70 per cent, highlighting the disease’s significant burden in the country.

Young women aged 15 to 24 are particularly vulnerable due to limited access to sexual health education, stigma around STI treatment, and inadequate healthcare infrastructure.

How PID Affects Fertility

Mr Gani emphasised that one major consequence of untreated PID is infertility, warning that leaving it untreated can cause irreversible damage to the reproductive system.

“PID can destroy the cilia—tiny hair-like structures that transport eggs through the fallopian tubes,” he explains.

“When these cilia are damaged, fertilisation is hindered, increasing the risk of infertility and ectopic pregnancy.”

Ectopic pregnancy occurs when a fertilised egg implants outside the uterus, typically in the fallopian tubes, posing severe health risks.

Fibrosis, chronic pain

Mr Gani explained that aside from ectopic pregnancy, chronic pelvic pain is another complication stemming from PID.

He stated that fibrosis is the formation of excess scar tissue, as a result of injury, infections or chronic inflammation. He added that this forms as the infection heals, and when stretched, which could lead to persistent pain.

The gynaecologist stated that fibrosis prevents ovulation resulting in a lack of fertilisation.

“Fibrosis is formed due to PID covering the ovaries, preventing ovulation, or blocking the fallopian tubes, even if the cilia remain functional, thus obstructing the transport of sperm and egg,” Mr Gani stated.

Increased miscarriages

According to him, PID can affect pregnancy outcomes by damaging the endometrial lining of the womb.

He explained that if fertilisation occurs, the destroyed endometrium will become hostile to the fetus, preventing successful implantation, and leading to an increased risk of miscarriage.

Preventive measures

Speaking on preventive measures, Mr Gani noted that the best way to prevent PID is through lifestyle modifications and timely medical intervention.

“Practising safe sex, getting screened regularly for STIs, and seeking prompt medical attention for unusual symptoms such as pelvic pain or abnormal discharge can help prevent PID,” Mr Gani advises.

He also cautions against vaginal douching, which disrupts the natural balance of bacteria and increases susceptibility to infections.

Diagnosis, treatment modalities

Diagnosing PID involves a combination of physical examinations, medical history reviews, and laboratory tests.

The overall diagnostic workup includes taking a thorough history that details symptoms such as fever, lower abdominal pain, foul-smelling vaginal discharge, pain during intercourse, and backaches—all of which guide further investigations.

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He added that laboratory investigations expand the diagnostic process and are necessary for guiding appropriate treatment.

He added that in cases where the diagnosis is unclear, laparoscopy—a minimally invasive surgical procedure—may be required.

According to him, early diagnosis paired with timely antibiotic therapy is crucial to the effective management of PID and preventing serious complications.

Mr Gani said once a diagnosis is confirmed, timely administration of treatment through antibiotics—as determined by the results of culture and sensitivity tests—is recommended to control the infection before it progresses.

“In severe cases where pus accumulates in the reproductive organs, surgical drainage or excision may be necessary,” he added.