Expert: Pat G - 2/11/2010

Question
About 1 week after my abortion I was having lower back pain and red/brown discharge that smelled really bad. i didn't think that put me at risk for PID but now I'm getting worried because I began cramping more.

About 2 weeks (2 days from two weeks) I had protected sex with my boyfriend. My cramping and back pain worsened after this and now i'm worried i might be at risk for PID.

I've schedules a doctors visit but I'm wondering how long does it take for PID to ravage your reproductive organs? Am i at high risk for infertility?

Answer
Hello, Jen,

You seem to be well versed in the issue of PID. An odor in discharge can easily signify an infection of some kind. Abortion itself can infect a woman with an STD, partly because abortionists often don't sterilize their instruments properly, or re-use disposable instruments. This means a woman can get an STD if he used those instruments on another woman with an STD, before he used them on her. In addition, a surgical abortion can heighten a woman's chances because the abortionist scrapes the uterus with a sharp knife and cuts away the placenta, so there is now a raw, open wound into the woman's uterine tissue, and an infection can enter her body that way. This can also cause scar tissue to form, which means that portions of the uterus cannot accept an embryo seeking to implant.

Sex causes a release of hormones, which will arouse symptoms when things had been fairly quiet. You should also be concerned about the cramping, which can also be set off by sex, but could also indicate an injury of some kind. Perforating the uterus in a surgical abortion is fairly common.

The general instructions seem to be that a woman should not have sex for three weeks after abortion. Please be aware that there is no such thing as "protected sex". Condoms fail. And they can allow an STD to infect a woman regardless, in part because some micro-organisms are smaller in diameter than naturally occurring holes in the condom. For example, the HIV virus is 1/50th the diameter of such holes. As long as a woman's uterus hasn't healed, infection can easily enter into the uterine tissue.

Pill abortions upset the natural hormonal balance of a woman's body. This can also make a woman more susceptible to infections, because the new balance is more receptive to infection. In addition, a pill abortion can cause a normally mild infestation of Clostridium sordellii to rise to such a high level that it can cause toxic shock syndrome and kill a woman within hours. I have read of cases where women seemed to be fine for a few days, and then suddenly took a turn for the worse. The woman's body doesn't fight the infection in this situation. Nobody really knows yet what the long term implications for pill abortions are, with respect to fertility. Very few studies have been done. Pill abortions haven't been in use long enough for us to know the long term effects.

As for how long it takes for an infection giving rise to PID to ravage a woman's reproductive organs, that would tend to vary widely. If she has toxic shock syndrome, it would be very rapid, but it wouldn't end there. On the other hand, it is known and established that surgical abortions cause permanent infertility in about 10% of women who have them. There are also other problems, even if the woman can get pregnant. These include miscarriage and very early birth. Very early birth can cause one of several really serious birth defects. In addition, a surgical abortion can cause scar tissue to form over the openings to the Fallopian tubes, and if there is then an opening in the scar tissue large enough to admit sperm but nothing larger, it can lead to tubal pregnancy.

I would say that your fertility is definitely at risk. You might be lucky and not have any problems, but on the other hand, I would be like you and want it to be checked out thoroughly.

Under the circumstances, it would be wise not to have sex unless you are married. Having taken those kinds of risks with your body should cause you to become more cautious. Since "protection" is prone to failure, there is no good way to guard and protect your body as long as you continue to have sex. Your partner owes it to you not to put you at risk like that. If you are married, you have a couple of choices. One is to learn how to tell when you are fertile so you can avoid sex at that time, and the other is to be willing to accept a baby if you conceive.

Please raise all these concerns with your doctor. Don't stop asking questions until you are satisfied with the answers. I hope and pray you will be all right. Please let me know how things go.