PELVIC INFLAMMATORY DISEASE (PID)

Pelvic inflammatory disease (PID) is a disease of the upper genital tract. It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures. It is attributed to the ascending spread of microorganisms from the cervicovaginal canal to the contiguous pelvic structures. The clinical syndrome is not related to pregnancy and surgery.

But, as the terminology fails to pinpoint the precise organ or organisms involved, it is better to use the anatomical terminology in relation to which organ is involved in the infectious process. Thus, the better terminology should be either endometritis, salpingitis, pelvic peritonitis or tuboovarian abscess. The cervicitis is not included in the list. Many, however, prefer the term salpingitis as because it ultimately bears the brunt of acute infection. From a clinical perspective, it is more pragmatic to describe acute salpingitis as sexually transmitted or not.

Despite better understanding of the etiology, pathogenesis, improved diagnostic tools such as sonar or laparoscopy and advent of wide range of antimicrobials, it still constitutes a health hazard both in the developed and more so in the developing countries. The incidence of pelvic infection is on the rise due to the rise in sexually transmitted diseases. The ready availability of contraception together with increased permissive sexual attitude has resulted in increased incidence of sexually transmitted diseases and, correspondingly, acute PID.

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The incidence varies from 1–2 per cent per year among sexually active women. About 85 per cent are spontaneous infection in sexually active females of reproductive age. The remaining 15 per cent follow procedures, which favors the organisms to ascend up. Such iatrogenic procedures include endometrial biopsy, uterine curettage, insertion of IUD and hysterosalpingography. Two-thirds are restricted to young women of less than 25 years and the remaining one-third limited among 30 years or older.

Pelvic inflammatory disease is a major problem to the reproductive health of young women. PID may be asymptomatic or subclinical. Currently there is certain changes in the epidemiology of PID. (A) Shift from inpatient PID to outpatient PID. (B) Change in clinical presentation. Less severe disease is commonly seen. (C) Shift in the microbial etiology of more Chlamydia trachomatis than gonococcus and others.

Risk factors

- Menstruating teenagers.

- Multiple sex partners.

- Absence of contraceptive pill use.

- Previous history of acute PID.

- IUD users.

- Area with high prevalence of sexually transmitted diseases.

Teenagers have got low hormonal defence in response to genital tract infection. Wider area  of cervical epithelium allows colonisation of Chlamydia trachomatis and N. gonorrhoeae.

Protective factors

- Contraceptive practice

- Barrier methods, specially condom, diaphragm with spermicides.

- Oral steroidal contraceptives have got two preventive aspects.

- Produce thick mucus plug preventing ascent of sperm and bacterial penetration.

- Decrease in duration of menstruation, creates a shorter interval of bacterial colonization of the upper tract.

- Monogamy or having a partner who had vasectomy.

Patients with acute PID present with a wide range of non-specific clinical symptoms. Symptoms

usually appear at the time and immediately after the menstruation.

- Bilateral lower abdominal and pelvic pain which is dull in nature. The onset of pain is more rapid and acute in gonococcal infection (3 days) than in chlamydial infection (5–7 days).

- There is fever, lassitude and headache.

- Irregular and excessive vaginal bleeding is usually due to associated endometritis.

- Abnormal vaginal discharge which becomes purulent and or copious.

- Nausea and vomiting.

- Dyspareunia.

How to Have Good Sex without Penetration?

Many people are unaware of the fact that good sex without penetration is possible. The culmination of a heterosexual intercourse that leads to an orgasm is the penetration of the penis into the vagina. However, sex of this kind can sometimes bring many dangers because the absence of appropriate protection can result in various sexually transmitted diseases and unwanted pregnancy too. All these risks can be avoided by practicing sex without penetration, which is a very effective and pleasant alternative. This type of sex is preferred especially in situations where one of the partners or both of them want to protect their virginity or to live with sexual abstinence and also when sex that includes penetration is impossible for one or few reasons – certain damages to the sexual health of one of the partners, painful penetration etc. There are few ways in which people can have sex without penetration and what they all have in common is that they can be really exciting.

A very common way of having sex without penetration, which was practiced even among people living in ancient times, is by rubbing the penis between the thighs of the partner. This is a really easy method and anyone can perform it. You and your partner should first find a comfortable position and your partner should simply squeeze her thighs together in a way that will provide a pleasant feeling for your penis once you start to penetrate between them. In addition, you can always use certain amount of lubricant on your penis and the thighs in order to avoid the unpleasant feeling of rubbing and pain. Sex of this kind can be pleasant for both partners because you can stimulate the clitoris of your partner if you place the penis close to the vaginal opening. It is highly recommended to use a condom especially if this type of sex will be used only as foreplay.

Rubbing the penis between the partner’s breasts is another foreplay technique and a type of sex without penetration that is very popular. In many cases this technique ends in orgasm for at least one of the partners. The most appropriate position for sex of this type is when the woman rests on her back and the man sits down on her upper body so he could penetrate between her breasts. Just like in the case of thighs technique you should use lubricant which will allow comfortable rubbing and you can squeeze the breasts together or ask your partner to do that. In order to provide mutual pleasure you can use your fingers to stimulate the nipples on the breasts or the clitoris. Your partner can stimulate your penis with her lips if she puts a pillow under her head.

Sex without penetration can be an interesting and good foreplay or enrichment of the sexual relationship and it can easily replace sex with penetration if it is needed. The examples we have mentioned in this article are not the only examples of sex without penetration so feel free to use your imagination and explore your abilities.

Sexual Health Concerns that you need to taken into account

The crazy, obsessive thing called sex

The sexual act in itself is a matter of perception. For some, it is a means to channelize and purge the excessive energy that is generated within the body. For the creative and poetic mind, it is metaphorically a work of art. For the sentimentalists, it is a means to express love. Amidst all this, what we often tend to forget is the need to retain overall sexual health for its sustenance. Overlooking trivial symptoms becomes a matter of habit and we end up with more complications that we can handle. This is where the need for thorough sex education arises.

Sexually transmitted infection: an obstacle to normal living

What happens when two individuals come together to quench their sexual desire? A temporary feeling of satisfaction makes its mark upon the lovers. If we were to rephrase the question in any other way: what happens when two individuals, of which one of them is a carrier of a dormant STD, come together?

The disease gets another host to cling on to and prosper. Most STDs spread via sexual contact but the cause is always a bacteria or a virus. The carrier may be predominantly male or female, depending upon the disease and the symptoms may be present or absent at the time of transmission. There are, however, common symptoms that indicate an outbreak of the infection.

These include painful discharge through the rectum, heavy vaginal discharge, swollen glands in the genitalia, warts or rashes between the thighs, fever, headache and pelvic pain not related to the menstrual cycle to name a few.

Common sexually transmitted diseases to look out for

Chlamydia is a bacterial infection, more commonly inflicted upon females than males. The second-most common disease is Gonorrhea, which more often than not, leads to fertility complications. Genital warts are a primary symptom for those infected with the Human Papillomavirus, an infection invariably linked with cervical cancer according to research.

Nothing can kill human bodies with the intensity of HIV; the consequent AIDS virus is slow poison to the anatomy that breaks down little by little to its last breath. Genital Herpes is hard to diagnose while it is dormant within a body. The host may be having it for months without being aware of it, till the warts begin to show. The worst part about being inflicted with this virus is that it clings on to your dear life forever!

STD treatment: looking for a cure

Driven by shame and embarrassment, most STD victims look up the internet to seek self medication. This is the most impractical approach one could ever opt for. For one, you may get the necessary information that you are looking for, but the treatment bit should be left to the experts. Bacterial infections can be cured with regular medication but viruses are there to haunt you for life, therefore impossible to get rid of. Patients with their respective partners must undergo tests to medically confirm their diagnosis. Depending upon the condition, the patient and/or their partner would be prescribed antiviral or antibacterial medicines. Viruses require lifelong treatment in order to control the outbreak; disappearance of physical symptoms does not mean that the body has rid of it.