The main pathophysiological change in this disorder is an inflammation of the vagina or cervix. Cervical mucus generally provides a barrier from infection, but if the vagina is inflamed then this efficacy is reduced, allowing the inflammation to spread upwards into other areas of the reproductive system. This inflammation may be asymptomatic in the lower parts of the reproductive system, and may only be noticed during routine inspection of the area. It may also cause some pain or feelings of tenderness in the area, depending on the severity of the inflammation (Mitchell & Prabhu, 2013).
The second pathophysiological change that occurs in this disorder is scarring in the upper reproductive tract, including the fallopian tubes. The inflammation that occurred in the earlier stages of the disease can become severe, leading to this scarring, which is more likely to cause discomfort and pain to the patient. The immune response to the initial infection can make this worse and lead to epithelial damage of the vagina, cervix, fallopian tubes, and uterus (Taylor, Darville & Haggerty, 2013). This scarring can make sexual intercourse painful, and lead to unexplained spotting or bleeding from the patient, and can also cause pus build-up in the reproductive system.
The final pathophysiological change in this disorder is tubal blockage. This occurs when the inflammation and subsequent scarring become so severe that the fallopian tubes become blocked (Mitchell & Prabhu, 2013). In this case, the patient may have difficulty getting pregnant and experience chronic pelvic and abdominal pain (Taylor et al., 2013). It can also lead to ectopic pregnancies in some cases (Taylor et al., 2013). Scarring can also spread to the external surface of the liver, which makes the abdominal pain much worse and harder to diagnose.
- Mitchell, C., & Prabhu, M. (2013). Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infectious Disease Clinics of North America, 27(4), 793–809.
- Taylor, B. D., Darville, T., & Haggerty, C. L. (2013). Does bacterial vaginosis cause pelvic inflammatory disease? Sexually Transmitted Diseases, 40(2), 117–122.