Possible symptoms range from severe abdominal pain with fever in acute infection to mild, recurrent pulling and cycle disturbances in chronic courses. Acute adnexitis can mimic appendicitis, and ectopic pregnancy must also be ruled out. Typical complaints, which, however, do not always and not all occur together, are in detail:
- Acute adnexitis: most common are sudden, severe abdominal pain and fever above 38°C. The abdomen is often distended and tense. In addition, there may be vaginal discharge with an unpleasant odor, nausea, and irregularity in bowel movements or menstruation. Sometimes there is also pain during urination. The longer the infection lasts, the sicker patients feel. The touch or movement of the uterus, for example, during sexual intercourse or gynecological examination hurts.
- Chronic adnexitis: If the acute inflammation does not heal, for example, because of unsuccessful therapy, or if the healing leads to scarring and adhesions, complaints continue to occur or recur over months to years. Thus, affected complain of pain in the lower abdomen or back, especially during sexual intercourse or menstruation, constipation or even general reduction in their performance, fatigue and loss of appetite.
Complications in the acute stage are a spread of inflammation to neighboring organs such as the appendix and peritoneum, which can lead to a life-threatening situation (acute abdomen). What is feared and frequent is the risk of the fallopian tubes becoming stuck. This greatly increases the risk of abdominal pregnancy and infertility (sterility): After the first adnexitis, the sterility rate is already 12%, and each subsequent one doubles it! This means that after four ovarian inflammations, the probability of getting pregnant in the normal way is close to zero.
How is the diagnosis made?
First, the doctor will ask questions about symptoms and illnesses that have been experienced. Smoking and sexual habits are also important. During the gynecological examination with the vaginal mirror, swabs are taken for microscopic examination and to grow the germs in a culture. On palpation, the uterus and fallopian tubes can often be felt as swollen and are tender to pressure. In addition, blood is examined for signs of inflammation; an ultrasound examination is used to rule out other diseases and to detect complications such as an abscess. If an abdominal pregnancy is suspected, a pregnancy test is performed. If no definite cause for the symptoms can be determined, an abdominal endoscopy (laparoscopy) may be performed.
