Adnexitis: the Inflammation of the Ovary and Fallopian Tubes

Many women find a disease of the female reproductive organs extremely distressing. The discomfort is often joined by feelings of shame and fear of infertility. Since adnexitis not infrequently takes a chronic course, a visit to the gynecologist should not be postponed even if symptoms are mild.

What is adnexitis and who is affected?

Inflammatory conditions can occur in the fallopian tubes and ovary, technically known as salpingitis (salpinx = Greek for trumpet, the shape of which the fallopian tubes resemble) and oophoritis (oo = Greek for “egg”). Since both structures are almost always involved in an infection, gynecologists usually speak of adnexitis (adnex = appendix), i.e. an inflammation of the appendage structures of the uterus.

Especially in English-speaking countries, the term PID (pelvic inflammatory disease) is often used. In addition to adnexitis, this also includes inflammation of the uterus (endometritis). The reason for this is that the infection is usually caused by germs rising from the vagina, which then infect all the female reproductive organs located in the pelvis.

Adnexitis mainly affects sexually active women aged 15-25 years; it is estimated that 1-2% of women in this age group develop the disease. It particularly affects smokers, women with frequently changing sexual partners, IUD wearers, and patients who have had vaginal lavage or abdominal surgery (e.g., curettage).

How does adnexitis develop?

The cause is infection, almost always with bacteria. Germs can enter the fallopian tubes and ovaries in three ways: ascending from the vagina (ascending), “descending” from neighboring organs such as the appendix or rectum (descending), or washed up through the blood (hematogenous):

  • Ascending infection: this route of infection is by far the most common. In about two-thirds of cases, an infection in the lower genital tract with chlamydia or gonococcus is initially the underlying cause. The inflammation makes the barriers, e.g. at the cervix of the uterus, more permeable and these and also other germs can penetrate more easily. They lead to inflammation of the cervical mucosa (endocervicitis), then migrate through the uterus and subsequently up the fallopian tubes. The same applies to gynecological procedures or after childbirth – the natural defense mechanisms may also be impaired and thus germs are prepared the way.
  • Descending infection: if neighboring organs are inflamed, the pathogens can spread from there: either – if, for example, the appendix is tight – by direct contact or via the lymphatic flow. Rarely, this can also happen in the course of surgery (eg, appendectomy).
  • Hematogenous infection: this route of spread via the blood is comparatively rare. Underlying then usually an infection such as tuberculosis, mumps or influenza, which can lead to severe general symptoms.