About one million women develop it each year, but perhaps as many more may not even know they have it. With the exception of AIDS, pelvic inflammatory disease (PID) is now considered the biggest sexually transmitted threat to women’s health. An infection of the uterus or fallopian tubes, PID can lead to infertility, ectopic pregnancy (in which the embryo lodges outside the uterus, commonly in the fallopian tubes), or internal problems that may require surgery to repair. Severe cases can be fatal: Every year more than 200 women in the United Stated die from PID.

Unlike AIDS, PID can be cured, but not always before it has irreparably damaged one’s reproductive organs. About one million women develop it each year, but because of the escalating rates of infertility and ectopic pregnancy, some researchers have recently come to believe that as many as a million more may have “silent,” or symptomless, cases.

For all its prevalence, PID remains something of a medical mystery. All too often, women don’t experience symptoms, and doctors don’t find clear evidence of the disease. There is no doubt however, about who gets PID: Most cases occur among women under the age of twenty-five. The more sex partners you or your partner have, the greater your risk of contracting a sexually transmitted disease that can lead to PID. The risk also seems higher among women who douche.

Symptoms

The most likely symptoms include a mild ache in the lower abdomen, a vaginal discharge with an unpleasant odor, painful urination, irregular bleeding and sometimes fever, chills, nausea and vomiting. At times the only clue may be a swelling or tenderness in a woman’s reproductive organs, which she and her doctor can sense during a pelvic exam. The only clue may be heavier periods or menstrual cramps that are slightly more intense than normal. Not surprisingly, many women ignore these symptoms. And doctors can be fooled, too.

If a doctor suspects PID but does not feel any swelling during a pelvic exam, she might do a vaginal or cervical smear, which could reveal an infection that indicates the possible presence of PID. Or she may perform culdocentesis, in which a needle is inserted behind the cervix to see if there is pus in the abdominal cavity, which also indicates infection.

Douching and PID

A number of recent studies suggest that women who douche frequently are at greater risk of contracting PID. In the largest report, which included nearly one thousand women studied over four years, the risk was highest among women who douche three or more times a month.

It’s not clear how douching could lead to PID, and more research is needed to confirm the link. Researchers emphasize that douching doesn’t cause PID, but may somehow spread the infection or infectious microorganism that causes it.

One theory is that douching may set the stage for PID by altering the normal bacterial environment of the vagina, making it less resistant to harmful organisms. Or it may flush microorganisms from the vagina and cervix in to the uterus where conditions may be more conducive to growth. There is also the possibility that women who douche does so in an attempt to relieve low-level symptoms of cervical or vaginal infection.

Since there is no known medical benefit to douching, doctors and other sexually transmitted disease (STD) experts advise women to avoid it.

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