Annexitis

Definition of adnexitis

It defines itself adnexitis any inflammatory process affecting the adnexa of the uterus, ie ovaries and tubes (hence the name "adnexitis"); in medical language, we speak more precisely of salpingovaritis, which can manifest itself in a chronic, subacute or acute form.

When the inflammation concerns only the salpingi, we speak of salpingitis (a phenomenon which is also very frequent), while the term “pelvic inflammatory disease” is suitable to express the inflammation extended also to the peritoneum.

Incidence

It is estimated that annexes are a very frequent phenomenon: statistics record about one million cases per year in the USA. In general, annexes mainly involve young women, aged between 20 and 25, with intense sexual activity It also seems that adnexitis afflicts one in every 100 women. In other words and in other numbers, adnexitis represents 30% of gynecological disorders.
Adnexitis can also occur in the puerperal period, and in this case it is an inflammation that generally afflicts some women a few weeks after birth.

Causes

The factors that cause adnexitis are almost the same as those we analyzed in the "salpingitis" article, so much so that, often times, the terms are used indiscriminately as synonyms (even if it is not entirely correct, since they affect adjacent areas but different).
The most important causal factors predisposing the adnexitis are represented by microorganisms such as: Staphylococci, streptococci (pyogenic microorganisms, which cause inflammation), gonococci (germs responsible for blenorrhagia), tuberculous bacilli (sporadic cases) and Chlamydia. Bacteria generally spread through the blood or lymphatics, but can also reach the ovary (and generate infection) through the uterine mucosa and sexual intercourse. As already mentioned in the previous paragraph, adnexitis can also be favored by childbirth or by an abortion.
Obviously, the cooperation of the bacteria aggravates the pathology: for example, the gonococcus, promoter of blenorrhagia, can cause a considerable and excessive exudation inside the lumen of the tube which, in turn, favors the invasion of other bacteria in the tuba itself.

Symptoms of acute adnexitis

Adnexitis can be acute, sub-acute or chronic.
In "acute adnexitis," inflammation causes severe and sudden pain, similar to colic, in the area between the lower abdomen and the lumbo-sacral region; moreover, acute adnexitis causes a typical sensation of tension in the abdominal muscles , resulting in menstrual irregularities, dyspareunia (pain during intercourse) and possible fever. Acute adnexitis can be the cause or consequence of cervicitis and endometritis, three closely related pathological phenomena: the simultaneous presence of adnexitis, cervicitis / endometritis causes a copious loss of mucus from the genitals and fever.
Acute adnexitis is usually caused by puerperal (after childbirth, or following an abortion) and blenorrhagic (favored by gonococcus) bacterial infections.
Most of the time, acute adnexitis affects a single tube, but both can be infected: due to the inflammatory process, the structure of the tube undergoes significant alterations, which consist in the "increase in volume, congestion and production of a "purulent or serous exudation. Thus, the infection spreads to the ovary and peritoneum.
As for subacute adnexitis, the disorder is generally accompanied by tuberculous foci which evolve into chronic forms in most cases.

Symptoms of chronic adnexitis

Acute adnexitis, if not promptly treated, can also evolve into the chronic form, thus persisting over time with sometimes very painful episodes: chronic adnexitis, generally, does not cause a real fever, but a low-grade fever (slight body temperature alteration) , often accompanied by asthenia, vaginal discharge, loss of appetite and malaise in general.
From the morphological point of view, chronic salpingitis causes a deformation and swelling of the tube, with consequent formation of adhesions that favor further bacterial infections.
In a general sense, the typical symptomatological picture of chronic adnexitis does not differ greatly from the acute form, if not for the "intermittence of pain and the exacerbation of the same, especially following substantial physical exercises and efforts. It was evaluated that the worsening of symptoms often coincides with the period preceding the menstrual flow.
The most unfortunate consequence of the chronicization of adnexitis is sterility, a condition given by adhesions formed in the ovary, uterus and peritoneum, which in the long run can occlude the lumen of the tube.

Diagnosis and treatment

The gynecologist certainly represents the medical figure to whom the woman should turn from the very first manifestations of the symptoms listed above: a timely accurate examination is essential to identify the inflammation of the uterus and the infection caused by bacteria.
The therapy to treat adnexitis is aimed, first of all, at the destruction of the pathogenic bacteria that caused the damage, and secondly at making the patient heal from the inflammation.
When it comes to chronic adnexitis, the doctor may recommend the administration of targeted antibiotics for that given pathogen. Essential is the correction of "intimate hygiene, which must" be even more scrupulous in case of adnexitis.

The gynecologist must prepare the patient for a treatment that could take a long time and the woman must not be discouraged if the disorder persists even after a few months. In this regard, spa treatments are also recommended which, in addition to determining a positive outcome against adnexitis, also favor the relaxation of the woman, which is absolutely indispensable. In fact, it has been estimated that many women affected by adnexitis are considerably stressed: in this regard, spa treatments induce relaxation and are at the same time beneficial to combat the disorder.
In the most severe cases of adnexitis, the woman should undergo surgery for the excision of the diseased tissues and the preservation of productive capacity.