Author name: Diane

More than one million women in the United States alone suffer from pelvic inflammatory disease each year. Females under twenty years old are affected more often than women in a higher age bracket. Left untreated, it can cause infertility, ectopic pregnancy, subsequent scar tissue (adhesions), chronic pelvic pain, complications to an unborn baby if you are pregnant, cancer and many other serious, even life threatening problems. If ignored, more than 25% of women affected suffer some or all of these long-term effects, some of which may lead to the need for a complete hysterectomy. However, it is also one of the most preventable diseases if diagnosed and treated in time. What is Pelvic Inflammatory Disease and What Causes It? Pelvic inflammatory disease, or PID, is a serious complication that usually arises from exposure to a sexually transmitted disease or infection (STD, STI). Your cervix, located just above your vagina, usually protects bacteria from attacking your reproductive organs, which include the fallopian tubes, uterus, and ovaries. However, if you’ve contracted a sexually transmitted infection such as gonorrhea, syphilis or chlamydia, and it was allowed to go untreated, complications could arise. Infection could travel past the cervix and wreak havoc on your reproductive system, often causing irreversible damage. Although the cervix is usually shut tightly, and thus serves as a kind of protective barrier to the reproductive organs, it opens during childbirth or when menstruating to allow blood flow. Though regular sex does not penetrate the cervix, semen carrying an STD can linger outside of it. Then, much like a plunger forces blockage in a toilet or sink to push through pipes, any means by which the cervix is opened or penetrated can allow that STD or other bacteria to ascend to the reproductive system. Therefore, though the highest percentage of pelvic inflammatory disease incidents are caused by sexually transmitted diseases during unprotected vaginal, anal and oral sex. Other Ways You May Get Pelvic Inflammatory Disease: • Having an abortion• Engaging in sex with multiple partners• Having sex under the age of 25• Undergoing a pelvic examination• Having an intrauterine device (IUD) inserted• Undergoing other surgical procedures such as a D & C or endometrial biopsy• Using douches• Using tampons• Inserting foreign objects into the vagina• Undergoing surgical procedures to the uterus• The migration of normal human bacteria that has travelled to and past the cervix• Having a previous history of pelvic inflammatory disease. Symptoms of Pelvic Inflammatory Disease Often, there aren’t any symptoms until it has spread, particularly if the infection is caused by chlamydia. This makes PID hard to diagnose, especially in its early stages. You should consult your doctor if you experience any of the following: • Lower abdominal pain• Fever of 101° F or more• Chills• Uncomfortable or painful intercourse• Upper abdominal pain• Fatigue• Irregular bleeding or spotting• Discharge accompanied by foul smell• Nausea and vomiting• Chronic pelvic pain• Fainting• Difficulty or pain when urinating• Pain when walking (PID shuffle)• Symptoms of dehydration• Sharp abdominal pain worsening over a period of several days that mimics appendicitis. If symptoms are unbearably severe, this may indicate that infection may have spread into the blood stream. You should seek immediate medical attention, as the situation may become life threatening. How is Pelvic Inflammatory Disease Diagnosed? A series of tests may be necessary to isolate a positive diagnosis of pelvic inflammatory disease. Your doctor will want to perform some or all of the following: • A complete and thorough examination of genital organs and abdomen which may include taking cervical cultures.• Manual probing of the vagina to feel for inflammation or ovarian tenderness.• Blood tests and cultures to check blood counts and to determine if you might be pregnant.• A urine test to look for traces of blood, cancer or other diseases.• Tests to check for the existence of any sexually transmitted diseases such as syphilis, hepatitis, HIV, chlamydia, gonorrhea, herpes, genital warts, etc. Testing for a Positive PID Diagnosis • An ultrasound, especially if the ovaries are too painfully sensitive for a manual probe. Sound waves can create an image of your reproductive organs for assessment.• An endometrial biopsy to examine a sample of the lining of the uterus.• A laparoscopy to pinpoint a more accurate, positive diagnosis. Treatment for PID If you are positively diagnosed with pelvic inflammatory disease, the treatment is usually an antibiotic shot or course of antibiotics. Sometimes both are required. In the event the actual bacteria causing the infection cannot be determined, additional medication may be recommended. Your doctor will discuss all options with you. Depending on the severity of your case, you may be required to be hospitalized on an inpatient basis, especially if there are more advanced complications such as ovarian abscesses. Sometimes, even surgery may be necessary. If your doctor has ascertained that your pelvic inflammatory disease is caused by an STI, your partner will also need to be treated in order to stop any continuing transmission. Of course, all sexual activity will need to be discontinued until you are confirmed infection-free. What Can I Do to Avoid Getting Pelvic Inflammatory Disease? There are many precautions you can take to avoid getting this disease. Most are simply safe practices such as: Finally, statistics show that teenagers are having sex more often and at an earlier age than ever. Because the incidence of pelvic inflammatory disease is highest in girls under 20, it’s important to educate our youth, both male and female, in the practices of safe sex. Though discussion regarding intimacy is still a delicate one for many parents, an open and frank dialogue can help future prevent issues. Our Doctors are Pelvic Health Experts At Cherokee Women’ Health Specialists, our physicians have decades of combined experience that enable us to diagnose, treat, correct, and answer any questions regarding not just pelvic inflammatory disease, but also the many other different disorders that can affect a woman’s genital health and reproductive system. Our staff includes Female Pelvic Medicine Reconstructive Surgeons (FPMRS). These specialists

Almost every woman knows annual gynecological checkups and regular pap smears are important to maintaining good pelvic health. Sometimes, though, things go wrong down below and we begin to hear about tests and procedures that not only sound intimidating, but are hard to pronounce. One of those procedures may be urethrocystoscopy, a multisyllabic word that sounds as complicated as it is to spell. Based on symptoms you’ve mentioned having to your doctor, he or she may have recommended urethrocystoscopy to further investigate and diagnose your problem. What is Urethrocystoscopy? Simply put, urethrocystoscopy or cystoscopy is an examination of the bladder and urinary tract. An instrument is inserted into the urethra, the tube or duct that empties urine from your bladder and out of your body. This instrument is called a cystoscope and assesses any damage, disorder, disease or irregularity. What is a Cystoscope and How Does it Work? A cystoscope is a long tube with a light and camera on one end. The other end is equipped with lenses just like a microscope or telescope. As the doctor slowly probes the area to be examined, the camera will project pictures onto a screen to study. Some cystoscopes also have flexible glass called optic fibers that can generate an image from the probe end to the examiner’s viewing lens. Depending on your particular case, your doctor may opt to use a cystoscope that is either hard and rigid or soft and flexible. He may also use one equipped with an extra tube in order to perform surgical procedures or immediately correct other problematic urinary issues. For biopsy purposes, or for surgical procedures, the rigid cystoscope is used, but if your doctor is simply investigating the area to look for whatever might be ailing you, the flexible tool is used. Sometimes, a ureteroscope, which is similar to a cystoscope, but of a thinner caliber, is better suited for the procedure if it’s necessary to remove stones or other blockages high in the urinary tract. This apparatus allows the physician to push a wire equipped with a basket through the ureteroscope’s extra tube to remove the stone. It also enables him to insert a laser fiber to break up larger ones that will later pass harmlessly during normal urination. That Sounds Terribly Painful. Is it? No. At worst, urethrocystoscopy can be uncomfortable and you may experience a burning sensation, along with the urge to urinate while the tube is being inserted. For a flexible cystoscopy, a local, often topical anesthetic is given before the procedure with plenty of time to take effect. If a rigid cystoscope is used, local anesthetic can be equally effective, but a general one can be used as well. Why Would I Need a Urethrocystoscopy? This procedure may be warranted if you’re experiencing or complaining of the following: • Repeated urinary tract infections• Kidney stones in the kidney ducts (ureters)• Blood in your urine (hematuria)• Pain or discomfort when urinating• Suspicious cells found in your urine sample• Suspicious polyps, tumors, growths or cancer in the ureter• A necessity for a bladder catheter• Urinary tract stones• Overactive bladder• Chronic pelvic pain• Incontinence• Interstitial cystitis• Any blockage that might be impeding your urinary flow, or causing a narrowing in your ureters. What Preparations are Necessary for a Urethrocystoscopy? Your doctor will discuss any preparations necessary. In some cases, with a weakened immune system, you may be prescribed an antibiotic prior to the examination. A urine sample may also be required. Make certain your physician is aware of any and all medications you may be taking. This includes vitamins and supplements. You may be asked to discontinue some of them to prevent excessive bleeding during the procedure. Unless you’ll be given a general anesthesia, you can probably eat and drink normally that day, but again, check with your doctor in case you may need to fast. What Can I Expect During the Urethrocystoscopy? First, you will be asked to change into a gown and empty your bladder. When you are finished, you will be led to a table, asked to lie down on your back, and possibly put your feet into stirrups. Depending on your case, you may be given an antibiotic to avoid getting a bladder infection. At this time, the area will be cleaned and sterilized and you will be given anesthesia. If it is general anesthesia, you won’t remember much after this point until you wake up. If your doctor has opted for a regional or local anesthetic, a sedative may be provided to calm you as you will feel some sensation during the examination. The area of the urethra will be treated with a numbing agent and checked to make sure that you are properly desensitized. The lubricated probe will now be gently inserted into your urethra. You may experience a burning sensation, coupled with a need to urinate. As the scope moves through your bladder, your doctor will be watching through the lens. He will then flood your bladder with a sterile solution, enabling him to assess the situation. Again, you may feel the need to urinate. The entire urethrocystoscopy with local anesthetic will take about 5 minutes, and perhaps 15 to 30 if using general anesthesia. Complete results may be immediate or they may take a few days. What Happens After? Urethrocystoscopy doesn’t usually have too many side effects, but you should take note of the following: • If general anesthesia was required, you may be somewhat groggy and should avoid driving or operating machinery. It would be wise to have someone stay with you for a few hours or even the rest of the day if possible.• You may need to urinate more often for a few days. Void as often as you need to and do not hold it in. Urinating whenever your body urges you to can prevent clots from forming in the bladder and creating possible blockages.• It’s normal to see a little blood in your urine, especially if you had