PELVIC INFECTION AND FEMALE FERTILITY
Dr. Martin Akpan
It is a matter of curious mentation (reasoning) and worry that despite the great advances made this century in medicine, particularly in the area of antibiotics research and manufacturing, pelvic infection still remains a potent source of misery and frustration for women in the developing countries. The reasons for this state of affair are not far-fetched: Ignorance, poverty, indiscriminate and unprotected sex, cultural inhibitions and the growing practice of self-medication are some of the factors responsible for our inability to tame this fissiparous (divisive) scourge.
Pelvic infection may be acute or chronic and is easily one of the commonest causes of infertility in women in our community. Caused by a wide range of micro-organisms including gonococci, streptococci, staphylococci, Esch, Coli, Clamydia and Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), the infection may involve the whole of female reproductive system (i.e cervix, corpus, uteri, fallopian tubes, ovaries, etc) or part of it and may even extend the vagina and uterus (womb) as seen after an abortion or delivery of a baby. Not uncommonly, it may also be an offshoot of gonorrhea, a sexually transmitted disease (STD). Rarely, it may follow an insertion of intrauterine contraceptive device (IUCD) in a family planning clinic.
Additionally, infection can come from the intestinal tract. An inflamed appendix (appendicitis) for instance, may share its inflammation with the contiguous right fallopian tube with which it makes contact and through this involve the whole pelvis. Besides, infective germs. Notably tuberculous organisms can gain access to the pelvis through the bloodstream. For example, in military (widespread) TB, the tuberculous organism is carried by the bloodstream from the primary site (the lungs) to the womb and fallopian tubes which affect more often than not result in infertility.
In acute infections, an experienced and painstaking doctor who has established a good rapport with his (or her) patients would almost always elicit a history of recent uterine instrumentation or manipulation including abortion or delivery or STD, notably gonorrhea. The patient who characteristically feels ill, usually presents with lower abnormal pain which is aggravated by movement. Expectedly, therefore, she prefers resting on bed. Other features of acute pelvic infection include fever and profuse purulent vaginal discharge. There may also be vomiting and menstrual upset. These symptoms may subside in a few days if the offending organism is of low virulence (strength). On the other hand, a high virulent may cause deterioration of symptoms. Other factors that may result in deterioration and chronicity include delay in instituting treatment, inadequate treatment and self-medication. Besides, tuberculous organism is known to be associated with chronic pelvic infection ab initio.
Apart from infertility which may result from damaged tubes, adhesions and tubo-ovarian abscesses or cysts, pelvic infection may give rise to a litany of complications such as ectopic pregnancy, heavy menses, dysmenorrheal (painful menses), irregular vaginal bleeding, chronic pain or ache in the back and lower abdomen, dyspareunia (painful coitus) abnormally positioned uterus (retroversion), chronic vaginal discharges, miscarriages, congenital abnormalities and even psychological disturbances which may be crippling for a young lady.
It is important therefore that all patients seek early treatment under qualified medical personnel. I dare say pelvic infection presents a prototypical situation where a stitch in time truly saves nine.