procedures. The doctor closes the speculum’s
blade to withdraw the speculum.
See also KEGEL EXERCISES; PREVENTIVE HEALTH CARE
AND IMMUNIZATIONS.
pelvic inflammatory disease (PID) A bacterial
INFECTION involving the UTERUS, FALLOPIAN TUBES,
CERVIX, and VAGINA. Untreated PID has the poten-
tial to become life threatening if it spreads to
involve the peritoneal membrane (PERITONITIS), the
tissue that encloses the abdominal cavity. Because
PID can cause scarring within the fallopian tubes
that occludes them (blocks the tubes’ openings),
chronic or recurrent PID is a leading cause of
INFERTILITYin women. PID is a significant health
concern in the United States with doctors diagnos-
ing more than one million women with it each
year, about half of whom have permanently
impaired FERTILITYas a consequence.
The most common cause of PID is recurrent or
untreated infection with SEXUALLY TRANSMITTED DIS-
EASES(STDS) such as CHLAMYDIAand GONORRHEA.
Other causes include infection that occurs as a
postoperative complication after a surgical proce-
dure such as DILATION AND CURETTAGE(D&C) or elec-
tive ABORTION. A less common cause of PID is
infection resulting from an intrauterine device
(IUD), a form of long-term birth control.
Symptoms and Diagnostic PathIt is possible to have PID, especially chronic PID,
with few or no symptoms. Many women who
have PID typically appear quite ill, however, and
may have FEVER and chills in addition to other
symptoms. Such symptoms may include
- yellowish or greenish malodorous (foul-
smelling) vaginal discharge - lower abdominal tenderness, cramping, or PAIN
- NAUSEA, VOMITING, andDIARRHEA
- vaginal bleeding between menstrual periods
- irregular or unusually heavy menstrual periods
The diagnostic path includes PELVIC EXAMINATION
with vaginal discharge and tissue samples for labo-
ratory analysis and BLOODtests to evaluate the
presence of infection or INFLAMMATIONwithin the
body (such as elevated sedimentation rate, white
blood cell count, and C-REACTIVE PROTEIN). The
cervix and uterus are generally very tender to pal-
pation during the pelvic exam, which is a key
diagnostic criterion.Treatment Options and Outlook
Treatment is prompt administration of ANTIBIOTIC
MEDICATIONS, by intravenous (IV) or intramuscular
injection for severe symptoms and orally other-
wise. Antibiotic therapy may include two or more
antibiotic medications, depending on the identi-
fied BACTERIApresent in the vaginal and cervical
cultures. It is essential to take the full course of all
antibiotics as prescribed to completely eradicate
the infection, which cures the PID. ANALGESIC MED-
ICATIONSrelieve pain and reduce fever to improve
comfort. Possible complications of PID include
infertility, increased risk for ECTOPIC PREGNANCY,
and chronic pelvic pain. The likelihood of these
complications increases with each episode of PID,
though prompt diagnosis and treatment helps mit-
igate their risk.ANTIBIOTICS TO TREAT
PELVIC INFLAMMATORY DISEASE (PID)
ampicillin/sulbactam cefotetan
cefoxitin ceftriaxone
ciprofloxacin clindamycin
doxycycline gentamicin
metronidazole ofloxacinRisk Factors and Preventive Measures
The primary risk factor for PID is untreated STD
infection. Many people do not have symptoms of
STDs yet are infected and pass the infections to
their sex partners. Multiple sex partners and
unprotected sex are high-risk behaviors for STDs
and PID. Measures to prevent infection among
sexually active adults include mutual monogamy
and latex condom use with every sexual act.
See alsoHIV/AIDS; MENSTRUATION; SEXUALLY TRANS-
MITTED DISEASE(STD) PREVENTION.penis The male organ for URINATIONand SEXUAL
INTERCOURSE. The penis is an elongated, cylindrical
structure made of connective and erectile tissue
that extends outside the body from the base of the
pelvis. Ligaments attach the root of the penis (seg-
ment within the body) to the pubic bone at thepenis 317