Pelvic inflammatory disease (PID), or slapingitis, is a catch all term for a group of bacterial diseases of the uterus, fallopian tubes and ovaries. In addition to these, the bacteria that cause PID can also infect the vagina, throat and rectum. Men and women can both be affected equally

by these bacteria and, left unchecked, infected sexual partners can become part of a vicious cycle of continual re infection. The genitourinary tracts and reproductive organs of both men and women can be damaged by the bacteria which cause PID.

In women, PID is a major cause of fertility and reproductive illness, accounting for the majority of cases of acquired infertility and substantially increasing the risk of subsequent ectopic pregnancy (JAMA, 1988; 259: 1823-7; Am J Epidemiol, 1991; 133: 839-49). Other side effects of PID include abscesses of the ovaries and fallopian tubes and pelvic adhesions, often leading to dyspareunia (painful intercourse) and chronic pelvic pain. If a woman becomes pregnant with untreated PID, her chances of giving birth to a live baby fall dramatically with the severity of her condition from 90 per cent with a woman who has a mild form of the disease to 57 per cent for those with severe disease (Am J Ob Gyn, 1998; 178: 977-98). A woman with recurring PID is eight times less likely to achieve a live birth, compared with a woman with a single mild episode of PID.

PID is usually brought on through sexual contact, but this is not the only route through which bacteria find their way into the normally sterile uterus.

The bacteria contamination may, in fact, happen during gynaecological procedures involving dilating the cervix and/or inserting instruments into the uterus. These can include abortion, D&C, tubal ligation, gynaecological examinations and insertion of an IUD. The risk of contracting an infection is also thought to be greater in the first few weeks after birth, when the cervix is still open. Bacteria can also be transferred from the gastrointestinal tract into the vagina from faeces either through poor hygiene or anal intercourse.

PID appears to be mostly a young woman’s disease. Sexually active adolescent girls aged 15 to 19 are more likely to be hospitalised with PID than adult women aged 25 to 29 (Ob Gyn, 1995; 86: 764-9; Morb Mortal Wkly Rep, 1991; 40: 1-25). It is not totally clear why this should be the case, except that younger girls may be more likely to have multiple sexual partners, less likely to take precautions such as using a condom, or less inclined to seek a medical diagnosis when vague symptoms begin to appear.

While PID can be caused by any number of sexually transmitted diseases, including gonorrhoea and myoplasma, two factors seem to contribute more than anything to its development: chlamydial infection and delay in seeking treatment (Sexually Trans Dis, 1998; 25: 378-85). In one study, 48 per cent of women with PID had delayed going to the clinic by one week and one third had delayed by more than one week (Sexually Trans Dis, 1997; 24: 443-8).

PID usually starts as an infection of the cervix that, for whatever reason (and there are a variety of them), spreads upward into the uterus, the fallopian tubes, the ovaries and into the abdominal cavity.

The most common symptoms in extreme cases are severe pelvic pain, which is usually noticeable with exercise or sexual intercourse, temperatures of 100.4 degrees F or more, chills, abnormal vaginal discharge and/or bleeding, fatigue, abdominal or back pain and just a general aching feeling all over. For many women acute symptoms never appear.

Many things aid in spreading the bacteria that cause PID. Frequent douching has been found to be a contributing factor. Research also draws a connecting line from PID to IUD use, specifically the now defunct Dalkon Shield. IUDs seem to aid in the spreading of pelvic infections of all varieties. The string attached to an IUD which hangs down into the vagina acts like a small ladder for bacteria to climb up and into the uterus.

If you do have an IUD, your doctor probably advises you to have it replaced every three to five years to help prevent PID. However, each time an IUD is replaced there is not only an increased risk of uterine perforation, but also an increased risk of PID due to the fact that it can take from one to six weeks for the cervical opening to shrink back to its normal size after the procedure.

In addition, the risk of getting an infection is higher during or immediately after your menstrual period. Bleeding seems to make it easier for bacteria to spread upward into the uterus and menstrual blood enhances bacterial growth.

Medicine has very little to offer women with PID other than antibiotics or surgery. Treatment can be complicated by the fact that more than one type of bacteria may be present.

In recurring acute cases, antibiotic use may be of benefit as a first step (some chlamydial infections will respond well to tetracyclines and erythromycin).

Unfortunately, because chlamydia lives within human cells, it may be difficult to entirely eradicate the organism with antibiotics alone. So, women who are experiencing a single mild to moderate first bout of PID may wish to take less aggressive steps.

To clear up a case of PID, practitioners (both alternative and conventional) will generally recommend complete bed rest, probably for a week or two. You will also be advised to refrain from sex to reduce irritation in the pelvic cavity.

An alternative practitioner will approach PID as he would any other bacterial infection anywhere else in the body by prescribing herbs and other treatments which help the body fight off infection naturally. Herbalist Kitty Campion has assisted many women in healing both chronic and acute PID with great success. She cautions that the natural route requires much dedication and persistence as well as considerable courage as the pain can often be quite extreme.

‘During acute attacks, I always recommend fasting on apple or carrot juice with plenty of potassium broth (a clear broth made from 1/4 thick potato peelings, 1/4 carrot peelings, 1/4 onions and garlic celery and 1/4 greens all preferably organic simmered on a low heat for one to two hours and taken in a mug with two desertspoons of yeast extract) for as long as the attack lasts, ensuring the colon is functioning extremely well. Hot and ice cold abdominal packs applied alternatively as long as the pain lasts are also helpful.

‘All forms of hydrotherapy, including Turkish baths, cold plunges, sauna and cold showers help to get general circulation moving and should be taken at least twice a week. Alternative morning and evening hot and cold sitz baths (shallow baths which come up only as far as your hips) with lavender oil added are also extremely helpful.’

You might also consider taking natural antibiotics. Kitty Campion recommends up to 360 drops of echinacea tincture daily during acute attacks.

Echinacea has repeatedly shown to be an effective herbal antibiotic with few side effects even at very high doses (Econ Med Plant Res, 1991; 5: 253-21; Can Pharm J, 1991; 124: 512-6; Arzneim Forsch, 1985; 35: 1069-75).

Garlic should be taken liberally in all its forms and has much scientific literature to back up its use as an anti bacterial agent (Phytother Res, 1993; 7: 278-80; Phytother Res, 1991; 5: 154-8; Planta Med, 1992; 58: 417-23; Med Hypothesis, 1983; 12: 227-37).

Goldenseal has also been shown to be effective against a wide range of bacteria, including chlamydia (Antibiotics, 1976; 3: 577-84; Sabouraudia, 1982; 20: 79-81).

Besides a wholefood diet, daily supplements of antioxidants and essential fatty acids will help to take the strain off your immune system.

The homoeopathic remedy Folliculinum, a potentised form of oestrogen, has no provings to date, but practitioner experience suggests that it may be useful in cases of PID (Am Hom, 1997; 3: 80-4). It is generally taken in single doses of 30C in acute cases.

Other measures you can take include reducing the number of sexual partners you have. Always use a condom even if you are on the Pill, and get tested for STDs every six months if you are in a high risk category.

If you smoke, it’s time to stop since smokers are at greater risk from PID. You should change tampons and pads frequently when you menstruate and always wipe from front to back after a bowel movement to keep bacteria from the faeces from entering the vagina.

The result is that the heat generated by driving for long periods could reduce male fertility (Hum Reprod, 2000; 15: 1355).

The discovery is nothing new. Several earlier studies found that the wives of men who drive for a living such as long distance lorry drivers, salesmen and taxi drivers took longer to conceive than those whose husbands were deskbound.

So, next time a cab driver asks you for a tip, tell him to walk.

It is the first complete study to look at all the data, and one that is badly overdue, considering that as far back as 1988 more than two million women in the US alone had taken some sort of infertility drug.

The study, led by Dr Mary Anne Rossing, is based on 3,837 infertile American women in Seattle, Washington between 1974 and 1985. It discovered that 11 in the group reported an invasive or borderline malignant ovarian tumour against an expected average of 4.4. Of these, nine were taking clomiphene and five of these for longer than a year.

It adds further fuel to earlier fears of a link between the drug and cancer. NEJM, 22 September 1994.

Low fertility in men can run in families, a new study has discovered. Scientists at Leeds University in England discovered that men with low sperm counts also had brothers with no children. Of the 148 men monitored, 16 per cent had childless brothers, whereas men with two or more children had none.

!ABMJ, 3 September 1994.

That is the conclusion of US researchers who examined the use of drugs in 1494 infertile women. They found that drug treatment for this group resulted in 441 births: 314 single babies, 88 sets of twins, 22 triplets, 10 quadruplets, five quintuplets and two sextuplets.

Apart from a less than 30 per cent success rate, giving high doses of fertility drugs carries considerable risks, including multiple unwanted babies, who often have poor health and a greatly reduced chance of survival. It can also profoundly disrupt a woman’s hormonal balance and threaten her own health.

The math is simple. The higher the dose of drugs, the greater the number of follicles stimulated to release eggs at one time. While doctors understand the mechanism by which this happens, they have no means of controlling the way egg producing follicles respond to drug treatment.

High doses of fertility drugs are often given to infertile women because low doses do not increase the chances of conceiving. IVF, by comparison, has around the same success rate without the potential adverse effects (N Engl J Med, 2000; 343: 2-7).

A report, which examined data in a recent government report entitled “Dietary and Nutritional Survey of British Adults”, concluded that three quarters of women of childbearing age were deficient in energy and protein levels (as set by the Recommended Daily Allowance).The report also noted that women between l6 and 49 were low in virtually every nutrient many B vitamins (including folic acid), vitamin E, iron, magnesium and zinc.

The report implied that this poor showing may have something to do with the high levels of infertility and also the high levels of stillborn, low birth weight and handicapped children born to women who had undergone assisted conception.

A French study looked at 225 men from the Litoral Sur farming region of Argentina attending their first infertility consultation between 1995 and 1998. The investigators examined lifestyle, occupation, clinical history and, crucially, environmental exposure to chemicals. They found that the men with the highest exposure to chemicals such as pesticides and solvents tended to have lower sperm quantity and quality.

They also found that these chemicals tended to have a greater adverse effect on men who had never had children compared with those who had. This may be the result of the relatively recent (since the 1940s) introduction of pesticides to Argentina. Damage to sperm may be most devastating when men are exposed to these chemicals from birth.

Environmental factors like heat, herbicides, environmental oestrogens, dry cleaning agents and medications (some antihypertensives, chemotherapy agents and St John’s wort) may have a harmful effect on male fertility. What has not yet been determined is why not all men react the same way to the same environmental toxins (Hum Reprod, 2001; 16: 1768-76).

When my oldest child was 7 and had to have a shot to go back to school, he too underwent genital examination and was extremely uncomfortable. I asked the doctor if it was necessary. He said yes. I asked until what age it was necessary. He said until adulthood. Then he went on to say that oftentimes little girls are so uncomfortable that they have to transfer out to a female pediatrician. In the late 60s and early 70s, my mother found a pediatrician who also forced me to remove all my underclothes, lay on my back and spread my legs so that he could spread my vagina with his hands and get a “good look”. I never remember a visit forgoing this experience until I was well into my teens. No explanation was ever given to me, and my “panic attacks” prior to the visit were considered to be quite ridiculous. L B, Miami Springs, Florida…..Thank you for calling attention to this subject and for sending in photocopies from a medical textbook on physical examination of infants and children. It emphasizes that it isn’t essential that the child be completely undressed during the course of the examination only the part of the body being examined and that direct visualization of the vagina and cervix aren’t considered part of the ordinary physical examination.

Our advice would be for parents to avoid “well children” general examinations; to save doctor visits for times that something specific seems to be wrong, and then ask the doctor to only examine the relevant body part. If your child has something wrong with his plumbing requiring that his genitalia be examined, it would be wise for you to explain beforehand that the doctor is going to have a look at it and why, and perhaps for you to demonstrate it yourself so that your child is not taken by surprise. Of course make sure to always be present. If your child clearly doesn’t want it, never force or restrain him.

Results of a study of 430 couples show that while the possibility of conception increased with increasing sperm concentration up to 40 x 104 /mL seminal fluid, it was also very important that the sperm were of normal shape (morphology) and motility.

The study found that a man with a lower sperm concentration is still likely to be fertile, providing a high proportion of the sperm present were of a normal morphology.

The study also found that sperm concentrations above 40 x 104 /mL did not make a man significantly more likely to impregnate his partner. Indeed, some men with sperm counts above the lower limits of normal (20 X 104 /mL, as defined by the World Health Organisation, may actually be sub fertile (Lancet, 1998; 352: 1172-7).

This is appropriate, because female fertility is grounded in female fat. It is an increase in female fat especially the achievement of a critical weight which means the girl has stored enough calories to sustain a foetus that is the physiological trigger for menarche. And female fat plays a crucial role in conception and in sustaining a healthy pregnancy.

Problems around fertility are common in thin women. If you are too thin, you may not be menstruating, you may be menstruating but not ovulating, you may be menstruating and ovulating but will have difficulty conceiving, or you may manage to conceive but will have difficulty carrying a pregnancy to term.

Yet when underweight women go to their doctors with fertility problems they are rarely advised to put on weight. Doctors as well as lay people believe that slimness is healthy and sexy.

This belief in the link between slimness and health is in fact fallacious. Ironically, over the decade in which slimness has come to be so closely identified with health, a number of comprehensive research studies have established that, contrary to popular belief, the longest living people in the population are those who are slightly overweight according to current ideals. According to these studies, the very thin die soonest even when smokers and those with cancer have been excluded and people who gain 10 pounds with every decade actually improve their life expectancy (see Never Too Thin, Prentice Hall, 1989 for a summary of studies).

Yet thin women with fertility problems are given drugs, not dietary advice.

Recently a leading endocrinologist, Professor Howard Jacobs of University College and Middlesex School of Medicine, spoke out against the practice of prescribing ovulation inducing drugs to underweight women, which he described as “reprehensible”. He is quoted as saying, “Underweight women have five times the risk of producing an underweight baby. Amenorrhoea [cessation of periods] is clearly nature’s way of protecting babies against subnormal nutrition (Guardian, 28 June 1991).”

Infertility causes heartbreak for many women. How much of it is simply caused by being a little too thin? Naomi Wolf (The Beauty Myth, Chatto & Windus, 1990) talks of the “One Stone Solution” the belief that everything would be OK if only you could lose a stone in weight. How often is there a “One Stone Solution” to infertility gain a stone and get pregnant?

What happens once the woman has conceived? When I was researching my book on miscarriage, I knew about the links between low maternal weight and low birthweight, but I could find no investigation anywhere of what I had come to suspect that very thin women had more problems of all kinds in pregnancy.

Subsequently, I came across a study carried out for the London Institute of Child Health (People: The International Planned Parenthood Federation Review, Vol 15, no 1) that looked at the relationship between mother’s weight and the risk of “pregnancy wastage” miscarriage, stillbirth and neo natal death. The research was done in Bangladesh, Cameroon and Sierra Leone yet it has relevance for the many undernourished women in our affluent society.

It was found that, “underweight women were much more likely to lose their babies: of the women who weighted over 42 kg (93lb), only 7 per cent reported pregnancy wastage, whereas 43 per cent of women under this weight had experienced it.”

A woman can increase her chances of having a healthy baby sixfold by not being underweight.

Poor nutrition and poor weight gain in pregnancy may be associated with other problems, too. American gynaecologist Tom Brewer has argued that toxaemia, the most dangerous condition of pregnancy, is largely caused by malnutrition in the mother (What Every Pregnant Woman Should Know, Penguin, 1979). He advocates a high protein diet in pregnancy, including two pints of milk and two eggs a day. There are also many studies which suggest that various handicaps, including spina bifida, are associated with poor nutrition before conception and at the start of pregnancy (BMJ, vol 282: 1509-11, 1981).

If you eat a nourishing diet and are not underweight before conception, you give your pregnancy the best possible start. Yet women who are planning to get pregnant are never advised to put on weight and to eat especially well. Once you are pregnant, it is essential to the health of both mother and baby that you maintain a good weight gain. Yet many women are still told by their doctors that they have put on “too much” weight.

In his widely read advice manual Pregnancy (Pan 1975), Gordon Bourne insists that “the importance of control of weight gain in pregnancy cannot be too forcefully repeated”, because “the welfare of both the mother and her child are directly related to it.”

This advice is rooted in now out dated research from the 1930s, which suggested that excessive weight gain in pregnancy might cause toxaemia. Yet many GPs regularly repeat these out dated assertions, presumably because they fit so neatly with prejudices about the virtues of being slim.

Not all women, just most, diet to be sexually attractive. But if we are told in pregnancy that we are gaining too much weight, all women will pay heed, believing it’s for the good of the baby. Here we see our society’s horror of female fat carried to extraordinary and damaging lengths, when women are given the impossible injunction that even when they’re pregnant, they must stay slim.

Extracted from Pleasure: The Truth About Female Sexuality (Harper Collins £16.99 (c) 1993 Margaret Leroy)

They fear that the safety of the procedure has not been proven, and that it could harm the fetus and pass on infertility to future generations.

A newer technique involves the injection of spermatids, the precursors of sperm, which are found in the testicles and semen of many infertile men.

Doctors at the Erasmus University in Rotterdam, the Netherlands, recently voiced concerns about the technique when five of the 12 women given sperm injections showed abnormalities in the fetus (WDDTY, vol. 6, no. 8).

Their concerns are shared by others, including Prof Axel Kahn at the Cochin Hospital’s Institute of Molecular Genetics in Paris. He argues that infertile couples can be treated just as well with donor sperm.

The technique was developed in 1992 in Belgium, and about 900 children have so far been born as a result. It is thought about 100 French teams are already practising the technique, even though the pioneers wanted it to be used by a few, controlled groups until its safety had been confirmed (BMJ, October 7, 1995).