Adnexitis: inflammation of the fallopian tubes and ovaries

Many women find a disease of the female genital organs extremely stressful. The symptoms are often accompanied by feelings of shame and the fear of infertility. Since adnexitis often takes a chronic course, a visit to the  gynecologist should  not be postponed even if the symptoms are minor.

What is adnexitis?

Inflammatory diseases can occur in the fallopian tubes and ovaries, which are technically referred to as  salpingitis  (salpinx = Greek for trumpet, the shape of which is reminiscent of the fallopian tubes) and  oophoritis  (Oo = Greek for “egg”). Since both structures are almost always involved in an infection, gynecologists usually speak of  adnexitis  (adnex = appendage), i.e. inflammation of the appendages of the uterus.

The term PID  (pelvic inflammatory disease = inflammation of the small pelvis) is often used, especially in English-speaking countries  . In addition to adnexitis, this also includes inflammation of the uterus (endometritis). The reason is that the infection is usually caused by germs rising from the vagina, which then infect all female reproductive organs located in the small pelvis.

Inflammation of the fallopian tubes and ovaries: who is affected?

Adnexitis predominantly affects sexually active women aged 15 to 25; an estimated 1–2% of women in this age group develop it. Particularly affected are smokers, women with frequently changing sexual partners, IUD wearers  and  patients who have had vaginal douches or procedures in the lower abdomen (e.g. scrapings).

How does adnexitis develop?

The cause is an infection, almost always bacterial. Germs can get into the fallopian tubes and ovaries in three ways: ascending from the vagina (ascending), descending from neighboring organs such as the appendix or rectum (descending) or washed up in the blood (haematogenous):

• Ascending infection:  This route of infection is by far the most common. In about two-thirds of cases, the underlying cause is an infection in the lower genital tract with chlamydia or gonococci. As a result of the inflammation, the barriers, for example at the cervix of the cervix, become more permeable and these and other germs can penetrate more easily. They lead to inflammation of the lining of the cervix (endocervicitis), then travel through the uterus and then up the fallopian tubes. The same applies to gynecological interventions or after childbirth – the natural defense mechanisms can also be impaired here, paving the way for germs.
• Descending infection:  If neighboring organs are inflamed, the pathogens can spread from there: either – if, for example, the appendix is ​​tight – through direct contact or via the lymphatic system. Rarely, this can also happen during an operation (e.g. an appendix removal).
• Hematogenous infection:  This path of spread via the blood is comparatively rare. The underlying cause is then usually an infection such as  tuberculosis ,  mumps  or  influenza , which can lead to severe general symptoms.

complaints and complications

The range of possible symptoms ranges from severe  abdominal pain  with  fever  in the case of an acute infection to a slight, recurring pull and menstrual disorders in the case of chronic courses. Acute adnexitis can   mimic appendicitis , and ectopic pregnancy must also be ruled out. Typical complaints, which do not always occur and do not all occur together, are in detail:

• Acute adnexitis:  Sudden, severe abdominal pain and fever over 38°C are most common. The body is often distended and tense. In addition, vaginal discharge with an unpleasant odor,  nausea , irregular bowel movements or menstruation can also occur. Sometimes there is pain when urinating. The longer the infection lasts, the sicker the patients feel. Touching or moving the uterus, for example during sexual intercourse or during a gynecological examination, is painful.
• Chronic adnexitis:  If the acute inflammation does not heal, for example due to unsuccessful therapy, or if the healing leads to scarring and adhesions, symptoms continue to appear for months or years, or repeatedly. Those affected complain of pain in the lower abdomen or back, especially during sexual intercourse or menstrual bleeding,  constipation  or a general reduction in their performance, tiredness and loss of appetite.

Complications in the acute stage are the spread of the inflammation to neighboring organs such as the appendix and peritoneum, which can lead to a life-threatening situation ( acute abdomen ). Feared and common is the risk of the fallopian tubes sticking together. This greatly increases the risk of pregnancy in the abdominal cavity and infertility (sterility): after the first adnexitis, the sterility rate is already 12%, with each subsequent one doubling it! This means that after four ovarian infections, the chance of conceiving normally is close to zero.

Adnexitis: how is the diagnosis made?

First, the doctor will ask questions about symptoms and past illnesses. Smoking and sex habits are also important. During the gynecological examination with the vaginal mirror, smears are taken for the microscopic examination and for cultivating the germs in a culture. During the palpation examination, the uterus and fallopian tubes can often be felt as swollen and painful to the touch. In addition, blood is examined for signs of inflammation; an ultrasound examination serves to rule out other diseases and to detect complications such as an  abscess. If there is a suspicion of an abdominal pregnancy, a pregnancy test is carried out. If no clear cause for the symptoms can be determined, a laparoscopy may be performed.

What therapy is there?

Hospital admission is usually required, and strict bed rest is always required. The focus is on the administration of an antibiotic that acts against a whole range of germs at the same time and in many cases is initially administered as an infusion. Painkillers are also   used, which also have an anti-inflammatory effect. Ice packs wrapped in a towel on the lower abdomen also reduce pain and inflammation. It is important to drink plenty of fluids and to empty your bladder and bowels regularly. Sexual intercourse should be avoided at first, the partner may need to be treated as well. Smoking is taboo.

Once the acute inflammation has subsided (which can be checked by blood tests), heat therapy with warm sitz baths, warm moist wraps and shortwave treatment can follow, which improves blood circulation and thus promotes healing. Those affected should see their doctor regularly for follow-up care. In the case of chronic courses, treatments such as mud baths and fango packs (preferably as part of a spa stay) are recommended – however, the therapy is often difficult and lengthy. Complications such as accumulations of pus or an  intestinal blockage occur may need to be punctured or operated openly. Even in the case of chronic courses that are not accessible to any other therapy, an operation may be indicated in which, for example, the fallopian tubes, ovaries and/or uterus are removed.

How to prevent adnexitis?

By far the most common cause of vaginal inflammation and adnexitis are germs that are transmitted during sexual intercourse. Therefore, the use of condoms is recommended, especially if you frequently change sexual partners. Everything that prevents vaginal inflammation makes sense – consistent but not excessive sexual hygiene. It is important to keep the vaginal environment in balance (and, for example, to refrain from excessive use of  soap  or intimate sprays); in addition to a healthy diet, plenty of exercise in the fresh air and a balance between work and leisure, it also makes sense to avoid nicotine. It is also useful – especially in wet  and cold weather  – to keep your feet and abdomen warm and to change damp clothing immediately.