Pelvic Inflammatory Disease (PID)

Recognition

Presentation: Dull, diffuse, or sharp lower abdominal pain (often worse after menstruation). Dyspareunia. Fever (> 101 degrees F), chills, lethargy, malaise. Heavy or purulent vaginal discharge with unpleasant odor. Low back pain
"Silent" PID: Many cases are asymptomatic, with damage only discovered during infertility investigation — this makes it particularly dangerous
Chandelier sign: Cervical motion tenderness on bimanual exam — the medical standard for presumptive PID diagnosis
Risk factors: Sexually active women with multiple partners, history of chlamydia or gonorrhea, recent IUD insertion, incomplete abortion or pelvic surgery
Key pathology: Ascending infection from the cervix to the upper tract. Inflammation causes scarring, adhesions, and tubal blockages. Ectopic pregnancy risk increases. Abscess rupture can cause life-threatening peritonitis

Acute PID: Systemically contraindicates rigorous massage until infection is medically resolved. The client is systemically ill
Chronic phase: Requires special caution with abdominal work to avoid irritating scarred tissues and adhesions
Post-recovery: Palliative support for anxiety and stress associated with chronic pelvic pain or fertility challenges

Emergency referral: Client with acute pelvic pain and high fever must be referred urgently to rule out ectopic pregnancy or peritonitis
Do not perform abdominal massage during acute infection
Menstrual link awareness: Early PID symptoms frequently occur just after menstruation when the cervical barrier is compromised
Partner treatment: Sexual partners must be treated to prevent re-infection (education point, not MT scope)

PID is the leading cause of infertility in young females due to permanent tubal scarring
Acute PID is a systemic contraindication for massage. Chronic PID requires caution with abdominal work
Many cases are asymptomatic ("silent"), causing damage discovered only during infertility investigation
The Chandelier sign (cervical motion tenderness) is the medical standard for presumptive diagnosis
A client with acute pelvic pain and fever requires urgent referral to rule out ectopic pregnancy or peritonitis