Pelvic Inflammatory Disease: The Hidden Enemy of Women’s Reproductive Health

Dr ASHWINI ANIL KUMAR SIRAPANASETTY

Pelvic Inflammatory Disease (PID) is a condition that continues to fly under the radar, despite being one of the leading preventable causes of infertility worldwide. Affecting millions of women annually, PID not only threatens fertility but also deeply affects physical, emotional, and sexual health.

Understanding PID

Pelvic Inflammatory Disease is an infection of the female reproductive organs—primarily the uterus, fallopian tubes, and ovaries. Most cases arise from untreated sexually transmitted infections (STIs) like Chlamydia and Gonorrhea. However, PID can also result from non-sexually transmitted infections after procedures like childbirth, miscarriage, or insertion of intrauterine devices.It is estimated that over 1 million women in India alone suffer from PID each year, but due to stigma and lack of awareness, many go undiagnosed until complications arise.

A Silent Invader

What makes PID especially dangerous is its insidious nature. Up to 60–70% of cases may be asymptomatic or present only mild discomfort. By the time a woman seeks medical help, considerable internal damage may already have occurred.

When symptoms do appear, they might include:

• Persistent lower abdominal pain
• Painful intercourse (dyspareunia)
• Abnormal vaginal discharge
• Fever, fatigue, and chills
• Painful or frequent urination
• Menstrual irregularities

The Long-Term Impact

If left untreated, PID can cause irreversible damage to the fallopian tubes, leading to:

• Infertility: 1 in 8 women with PID becomes infertile.
• Ectopic pregnancy: The risk is 6 to 10 times higher.
• Chronic pelvic pain: Persistent discomfort that can severely affect quality of life.
• Recurrent infections: Each episode increases the risk of complications.

What is more disconcerting is that many women may not experience any obvious symptoms, or may confuse mild signs like lower abdominal discomfort, unusual discharge, or irregular bleeding with common menstrual issues.

Modern Diagnosis and Management

Diagnosis relies on a combination of clinical evaluation, pelvic examination, ultrasound, and lab tests. In some cases, laparoscopy is used for confirmation.Treatment involves a course of broad-spectrum antibiotics, sometimes administered intravenously in severe cases. Early intervention yields excellent outcomes. However, partner treatment and sexual abstinence during treatment are crucial to prevent reinfection.

Prevention: A Shared Responsibility

• Safe sexual practices: Using condoms and limiting partners reduces risk.
• Timely STI screening: Especially for sexually active women under 25.
• Health education: Awareness in schools, colleges, and communities is vital.
• Postpartum care: Timely treatment of post-delivery infections is essential.
• Partner notification: Both partners must be treated to avoid recurrence.

Cultural and Social Barriers

In India, social stigma, lack of access to gynaecological care, and taboo around sexual health prevent many women from seeking prompt help. Many dismiss early symptoms as “normal” menstrual issues, which delays diagnosis.As a gynaecologist, I have seen how early counselling, safe sex education, and regular check-ups can dramatically reduce the incidence of PID. Involving men in conversations about STIs and reproductive health is equally important.

The Taboo Terrain

Despite the medical seriousness of PID, it is often brushed under the rug due to deeply entrenched social taboos around female sexuality and reproductive health. In many communities, PID is silently equated with “immorality,” leading to a triple burden for the woman: the disease, the stigma, and the silence.

1. Stigma around STIs - Because PID is frequently associated with STIs, there is a tendency to judge the moral character of the affected woman. This moral lens, steeped in patriarchal values, deters many from seeking timely medical help.

2. Fear of Marital RepercussionsIn marital contexts, a diagnosis of PID may spark distrust or unjust blame, especially if the couple is trying to conceive. Women fear being labelled as “infertile” or “damaged,” and often suffer in silence, bearing both physical pain and emotional trauma.

3. Lack of Comprehensive Sex Education Inadequate education about reproductive health means young women are often unaware of the symptoms, causes, and consequences of PID. In some cases, even educated women may struggle to navigate the medical system because they were never encouraged to openly discuss their sexual or menstrual health.

Towards a Healthier Discourse

a) Destigmatizing PID

We must begin by normalising conversations around PID — in clinics, schools, families, and media. PID is a medical condition, not a moral failing. Anyone with a uterus can develop it, regardless of their sexual history.

b) Empowering Patients with Knowledge

Education campaigns focusing on safe sex, STI screening, menstrual hygiene, and early warning signs of PID should be prioritised. Awareness leads to early diagnosis — which in turn prevents long-term complications.

c) Training Healthcare Providers

Sensitivity training for healthcare professionals is crucial. Creating a non-judgmental, confidential space encourages patients to speak openly and seek help without fear.

d) Partner Involvement

Addressing PID also involves educating and engaging male partners. This not only helps in treating the infection comprehensively but also reduces blame and improves relationship dynamics.

The Way Forward

Pelvic Inflammatory Disease is a classic example of a preventable tragedy. With proactive steps, we can spare women the trauma of infertility, pain, and psychological distress. It begins with awareness—at home, in schools, and in clinics.Let us break the silence around reproductive health. No woman should suffer in silence when help, hope, and healing are just a consultation away.

(Dr Ashwini Anil Kumar Sirapanasetty is an Obstetrics & Gynaecologist Surgeon. Tribal Reformist, Adolescent’s Sexual & Reproductive Health Counsellor, Expert Yoga Trainer & Senior Counsellor of Army Wives Welfare Association)