PELVIC INFLAMMATORY DISEASES

• Infection and inflammation of the upper genital tract involving the uterus, fallopian tube, and adjacent pelvic structures
• Usually, an ascending infection and may include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis
• Symptoms may vary considerably, while some women are asymptomatic, others may complain of mild pressure pain and discharge or present with signs of systemic inflammation, such as fever and severe abdominal pain

• PID is a polymicrobial infection (caused by several types of microorganisms)
• The most common organisms causing PID are Chlamydia trachomatis and Neisseria gonorrhoeae

Risk factors

• Young age
• Multiple sexual partners
• Cervicitis & vaginitis
• Smoking 

• Commonest symptom - Bilateral lower abdominal and pelvic pain 
• Abnormal vaginal discharge – purulent and/or copious
• Irregular and heavy bleeding
• Fever
• Nausea and vomiting
• Deep dyspareunia
• Post-coital bleeding
• Right upper quadrant pain (if there is perihepatitis)
• Temperature is elevated (>380C)
• Tachycardia

• Abdominal examination– tenderness on both quadrants of the lower abdomen
• Pelvic examination
  • Inspection - Foul-smelling purulent discharge
  • Speculum examination – congested cervix with purulent discharge from the canal
  • Bimanual examination – Tenderness in the fornices, which increases more with the movement of the cervix (cervical motion tenderness), tender adnexal masses, a fluctuant swelling in the pouch of douglas (pelvic abscess)
• Lab studies – Gram staining and culture of discharge collected from the urethra, cervical canal, etc. to identify the organisms
• Blood –Leucocytosis (WBC > 10,000/cu mm), Elevated ESR
• Serological test –VDRL, HBsAg 
• USG (TVS) –limited value. Dilated and fluid-filled tubes, fluid in the pouch of douglas or adnexal mass are suggestive of PID
• Laparoscopy –Gold standard
• Cervical & Urethral swab

• Antibiotic therapy
• Analgesics – IV fluids
• Symptomatic management – application of heat on the lower abdomen, sitz bath, bed rest
• Laparotomy
• Hysterectomy- In extreme cases of infection and severe pain

Ayurvedic Treatment

Internal Medicines

• Guduchyadi Kashaya – in itching, discharge
• Gugguluthiktaka Kashaya
• Drakshadi Kashaya
• Punarnavadi Kashaya
• Dashamoola Kashaya - in chronic PID and with hydrosalpinx 
• Pushyanuga Choorna
• Guggulu Panchapala Choorna –in controlling infection
• Triphala Guggulu
• Arogyavardhini Vati
• Chandraprabha vati
• Chandanaasava
• Punarnavaasava
• Lodhraasava
• Madhusnuhi Rasayana
• Khadali Madhusnuhi 

Procedures

• Yoni Prakshalana – Guduchyadi Kashaya, Triphala Kashaya, Nimba Patra Choorna + Haridra, Yashti + Panchavalkala + Khadira kashaya + Sphatika , Karanja Kashaya
• Yoni Pichu – Jatyadi Taila