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Fallopian tube and ovarian inflammation: adnexitis

by Josephine Andrews
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Inflammation of the fallopian tubes (salpingitis) and inflammation of the ovaries (oophoritis) often occur together. In summary, doctors then speak of adnexitis. The triggers are usually bacteria such as chlamydia or gonococci. Without treatment or with late therapy, the risk of infertility or chronic conditions increases. You can read more about the causes of fallopian tube and ovarian inflammation and the symptoms here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


quick overview

  • Symptoms : Acute inflammation often includes sudden, severe abdominal pain, fever, feeling very ill, abnormal vaginal discharge and unusual vaginal bleeding; chronic inflammation including dull lower abdominal pain, back pain , pain during sex , fatigue , digestive problems; sometimes no or hardly any complaints
  • Causes and risk factors : pathogens mostly bacteria such as chlamydia or gonococci (pathogens of gonorrhea), more rarely viruses ; Risk factors are e.g. B. young age, changing or new sexual partners, abdominal surgery, other sexually transmitted diseases, smoking
  • Diagnostics : Taking the medical history ( anamnesis ) , gynecological examination, swab from the cervix , blood test , ultrasound , laparoscopy
  • Treatment : Mostly conservative with medication (antibiotics, anti-inflammatory painkillers such as Diclofenac ) and physical measures (such as application of cold), in certain cases surgery (usually by laparoscopy), partner is also treated
  • Course and prognosis : With early and consistent treatment, good chances of recovery, without or with delayed therapy or severe course of the disease, possibly chronic course and complications such as abscesses, limited fertility or infertility , ectopic pregnancy , peritonitis, intestinal obstruction , blood poisoning
  • Prevention : Use of condoms, treat partner at the same time, intimate hygiene: not too much, not too little, no vaginal douches or products that destroy the natural vaginal flora

What is ovarian inflammation?

Inflammation of the ovaries (oophoritis) occurs almost exclusively together with inflammation of the fallopian tubes (salpingitis). Doctors call it adnexitis when ovarian inflammation and fallopian tube inflammation occur together. Inflammation occurs either unilaterally or bilaterally.

In medicine, inflammation of the ovaries and/or fallopian tubes is one of the “pelvic inflammatory diseases” (PID). These are defined as inflammatory diseases of the female upper genital tract ( uterus , cervix, fallopian tubes, ovaries). Other diseases that belong to PID include:

  • Inflammation of the neck of the womb (cervicitis) or the lining of the womb (endometritis)
  • Inflammation of the peritoneum limited to the small pelvis (pelvic peritonitis)
  • Abscess between fallopian tube and ovary (tubo-ovarian abscess)

Inflammation of the ovaries usually occurs when an infection travels up the fallopian tubes and into the ovaries. In many cases, sexually transmitted pathogens such as chlamydia trigger the inflammation, which is why sexually active women are often affected. Consultation with a doctor is important, otherwise the risk of infertility, permanent problems or other complications increases.

What are the symptoms?

The symptoms of ovarian inflammation and fallopian tube inflammation (adnexitis), as well as those of isolated fallopian tube inflammation, are different. Symptoms sometimes appear suddenly (acute), but sometimes they also occur over a longer period of time (chronic).

In some cases, sufferers feel no or only a few symptoms of fallopian tube and ovarian inflammation. For example, salpingitis caused by a chlamydia infection often causes hardly any symptoms.

In most cases, however, acute fallopian tube inflammation and/or ovarian inflammation or adnexitis causes the following symptoms, among others:

  • Sudden severe abdominal pain (left, right or often both sides)
  • Fever and/or severe illness
  • nausea and vomiting
  • Bulging, tense, hard abdominal wall
  • Unusual vaginal discharge (often purulent)
  • Unusual vaginal bleeding (including after sex)
  • painful intercourse (dyspareunia)

A hard, bloated abdomen with nausea and vomiting, fever, and severe acute abdominal pain are symptoms of an acute abdomen (“acute abdomen”) for physicians. Various diseases are triggers for this and all require immediate emergency medical treatment ! In the case of adnexitis, these symptoms are an indication that the inflammation has spread to neighboring organs.

If there is no (adequate) treatment for acute inflammation or if the infection leads to scar tissue changes, chronic adnexitis or chronic fallopian tube inflammation often develops. Typical symptoms then include:

  • Recurring, dull, alternating pain in the lower abdomen (on one or both sides), which sometimes worsens when sitting down or with physical activity
  • Uncharacteristic back pain or pelvic floor pain
  • Frequent tiredness
  • Tendency to depressive mood
  • pain during sex
  • Constipation, bloating , pain, or menstrual irregularities (less commonly)

Home remedies for adnexitis

If you notice symptoms of ovarian inflammation and/or fallopian tube inflammation, it is important that you contact a doctor or your gynaecologist immediately. This is the only way to clarify what exactly is behind it.

In the case of ovarian inflammation and/or fallopian tube inflammation, medical treatment is absolutely necessary. This is important, on the one hand, to reduce the risk of infertility and, on the other hand, to prevent a chronic course of the disease and other complications such as abscesses or potentially life-threatening peritonitis.

Measures or home remedies that can be used as part of the medical treatment of ovarian inflammation and/or fallopian tube inflammation are very limited. Even with the cold and heat applications, it is important that you follow the doctor’s advice. Otherwise, even these simple applications may do you more harm than good.

How do fallopian tube and ovarian inflammation develop?

Inflammation of the fallopian tubes and ovaries are usually triggered by bacteria . Chlamydia or gonococci (causative agents of gonorrhea = gonorrhea ) are most frequently responsible for the inflammation. The cause is often a mixed infection from different bacteria, including, for example, staphylococci, streptococci, Escherichia coli (coli bacteria) and clostridia.

Viruses rarely trigger inflammation of the fallopian tubes or ovaries, for example influenza viruses. In some cases, no pathogen can be identified.

How do the pathogens get to the fallopian tubes and ovaries?

The triggering germs reach the fallopian tubes and ovaries in different ways. Accordingly, doctors distinguish between the following infections:

Ascending (ascending) infection : Most often, the bacteria travel up the vagina and uterus to the fallopian tubes and ovaries. This risk is particularly high in the case of a bacterial vaginal infection (bacterial vaginosis) or when the cervix is ​​slightly (during menstruation) or wide (during childbirth ) open at the entrance to the uterus .

Interventions through the vagina (such as inserting an IUD, scraping ) also promote the rise of bacteria.

Descending (descending) infection : Doctors speak of a descending infection in adnexitis when the triggering germs from neighboring organs infect the fallopian tubes or ovaries – either through direct contact of the organs or via the lymphatic system. In this way, it is possible for appendicitis to trigger inflammation of the fallopian tubes and ovaries.

Hematogenous infection : The causative agents of various infectious diseases reach the fallopian tubes and ovaries via the blood and cause inflammatory processes there. Such hematogenous adnexitis occurs particularly often in tuberculosis (causative agent: tubercle bacteria).

However, other infectious diseases (such as influenza , mumps , scarlet fever ) in the blood sometimes also trigger inflammation of the fallopian tubes and ovaries.

Risk factors for fallopian tube and ovarian inflammation

Various factors favor the development of fallopian tube and ovarian inflammation. These include:

  • Young age
  • Changing sexual partners or current new sexual partner (less than three months)
  • Previous infection with a sexually transmitted disease (also of the sexual partner)
  • After abdominal surgery such as the insertion of an IUD (last three to six weeks), “artificial” insemination (in vitro fertilization) or an abortion
  • General risk factor: smoking , since nicotine consumption changes the composition of the cervical mucus. As a result, it no longer works as well as a barrier against rising germs.

How can fallopian tubes and ovaries be diagnosed?

The gynaecologist is the right person to contact if adnexitis is suspected. He first talks to the patient in detail in order to collect her medical history (anamnesis). Possible questions in this conversation are, for example:

  • What complaints do you have exactly?
  • How long have the complaints existed?
  • Have you ever had abdominal inflammation?
  • Do you have changing sexual partners?
  • Do you use the IUD for birth control? If so, when was it used?

This is followed by a gynecological examination . What is known as cervical sliding pain is typical of adnexitis : if the gynecologist moves the cervix slightly back and forth while palpating the internal genital organs, pain occurs. In addition, inflamed fallopian tubes and ovaries are usually swollen and tender.

An unusual discharge from the vagina and cervix is ​​also typical of acute adnexitis – the latter is also usually inflamed in the case of fallopian tube inflammation (cervicitis). The doctor therefore takes a swab from the vagina or cervix to have it examined for bacteria.

In this way, the exact pathogens can be determined in order to later use an antibiotic that is specifically effective against these germs.

The gynecologist also takes a blood sample from the patient. When there is inflammation in the body, certain blood values ​​are generally increased, such as the blood sedimentation rate and the number of white blood cells ( leukocytes ).

On ultrasound , the doctor detects signs of advanced adnexitis. These include thickened fallopian tubes and a build-up of fluid inside the fallopian tubes. An abscess is also visible on the ultrasound image.

The doctor usually conducts the examination via the vagina (transvaginal endosonography ). This method offers a better view of the abdomen than the ultrasound examination of the abdominal wall.

Fallopian tubes and ovaries can be assessed even more precisely by means of a laparoscopy . This is mainly used in ambiguous cases.

The doctor inserts an endoscope into the abdominal cavity through small abdominal incisions. This is a thin, tube-shaped instrument with a small camera and a light source at the tip (laparoscope). He examines the internal genital organs and, if necessary, takes a swab from the fallopian tubes, for example.

Laparoscopy serves not only in the diagnosis of adnexitis, but sometimes in its treatment. Fine medical instruments are inserted through the small abdominal incisions, which can be used, for example, to surgically loosen adhesions and make the fallopian tubes free again.

differential diagnoses

Diagnosing pelvic inflammatory disease is challenging because many different conditions can cause similar symptoms. Some of these are emergencies that require immediate treatment. The doctor therefore excludes these differential diagnoses as part of the examinations. These include, among other things:

How are fallopian tube and ovarian infections treated?

Doctors treat inflammation of the fallopian tubes and ovaries primarily conservatively : This means with medication and physical treatment measures such as application of cold.

Physical rest or bed rest in the acute phase are also advisable. It is also important to drink enough (unless there are medical reasons for limiting the amount you drink, such as heart failure).

Surgery is only necessary for adnexitis in certain cases, such as:

  • Symptoms of an acute abdomen
  • Other complications such as abscess or peritonitis
  • No improvement from conservative or drug therapy
  • Simultaneous pregnancy
  • A severe course of the disease

In any case, an operation requires a hospital stay. In many cases, doctors also refer affected women to inpatient treatment for the conservative treatment of fallopian tube and ovarian inflammation.


Doctors use antibiotics to treat acute fallopian tube and ovarian inflammation (since bacteria are almost always the cause):

  • Immediately after the diagnosis, the doctor usually prescribes one or more antibiotics that are generally effective against the most common adnexitis pathogens (broad-spectrum antibiotics).
  • As soon as the exact type of pathogen is known from a swab, the doctor adjusts the antibiotic therapy.

Those affected often receive the antibiotics as an infusion in the event of acute inflammation of the fallopian tubes and ovaries , which is why treatment often takes place in the hospital. In the case of milder courses, those affected also respond well to treatment in tablet form. Sometimes the women receive an injection of antibiotics into the muscle in addition to the start of therapy.

It is important to know that doctors prescribe the antibiotics for at least two weeks in most cases. Many of those affected are also ill for a correspondingly long time.

In the case of infections with gonorrhea or chlamydia as the cause of salpingitis or adnexitis, doctors recommend the appropriate treatment of the sexual partner (in the last 60 days). The affected woman should not have unprotected intercourse until the end of the therapy.

In addition, patients are prescribed medication to relieve the symptoms. Here, anti-inflammatory and pain-relieving drugs are usually used from the group of NSAIDs (non-steroidal anti-inflammatory drugs) such as diclofenac.

” Cortisone ” (colloquial term for corticosteroids such as prednisolone ) also has a strong anti-inflammatory effect . However, its use in adnexitis is controversial.

In the case of chronic adnexitis , doctors start antibiotic therapy if the affected person shows acute signs of inflammation.

Physical therapy

In the case of acute fallopian tube and ovarian inflammation , doctors sometimes recommend cold treatment. In many cases, an ice pack on the lower abdomen relieves the pain and prevents the inflammation from spreading. As a result, the inflammation-related increase in blood flow can be stopped somewhat.

As soon as the acute phase of the disease has subsided, doctors recommend heat treatment : moist, warm compresses on the lower abdomen now stimulate blood circulation. In some cases, this supports the breakdown of inflammatory tissue and prevents scarring.

Other methods of heat treatment also serve this purpose, for example warm sitz baths , fango packs or high- frequency heat radiation (short-wave diathermy).

The switch from cold to heat treatment must not take place too early, otherwise there is a risk of a relapse. Therefore, the doctor uses the body temperature and the rate of blood sedimentation to check whether the acute inflammatory processes have subsided.

Heat applications are also recommended for chronic adnexitis : the circulation in the lower abdomen can be increased with warm, moist compresses, mud packs or heat radiation. This sometimes relieves the persistent pain and loosens adhesions. Under certain circumstances, a spa stay (with fango packs, mud baths, etc.) makes sense.


In the case of acute adnexitis , an operation is necessary when another inflammation in the abdomen has spread to the fallopian tubes and ovaries via a descending infection (such as appendicitis). On the other hand, if the acute adnexitis has caused complications that cannot be treated conservatively. Two examples of this include:

  • Peritonitis: If the entire peritoneum is inflamed, it is necessary for doctors to open the abdominal cavity ( laparotomy ) and irrigate it.
  • Tubo-ovarian abscess: If a tubo -ovarian abscess does not respond to medication (antibiotics, anti-inflammatories), doctors usually perform surgery.

If the patient still wants to have children, doctors try, if possible, to surgically loosen the adhesions (adhesiolysis) and to make the fallopian tubes free again (tubal recanalization). This is usually done during a laparoscopy.

If, on the other hand, the family planning has already been completed or the conservative measures are not working, the doctor sometimes recommends a major operation in order to surgically clean up the area of ​​​​inflammation (focal sanitation) and to completely remove the organs involved. That means he removes the affected fallopian tube or tubes. It may be necessary to remove other organs such as the ovaries or uterus.

This radical intervention is often considered in women with chronic adnexitis , when conservative treatment is unsuccessful. The removal of the fallopian tubes and possibly the ovaries and uterus ( hysterectomy ) is then often the only way to completely eliminate the chronic inflammation and to end the pain that has often lasted for years.

Before removing the fallopian tubes and, if necessary, the ovaries and uterus, let your doctor explain in detail about the advantages and risks of the procedure. Because if both fallopian tubes and ovaries are removed, it is necessary to take sex hormones (estrogens and progestins) permanently afterwards.

What is the course of fallopian tube and ovarian inflammation?

If acute fallopian tube and ovarian inflammation is treated early and consistently, the chances of recovery are good. In many cases, the acute inflammation subsides within one to two weeks. Conservative therapy without surgery is usually sufficient. In the case of severe inflammation and adhesions, the woman’s fertility often remains impaired.

The earlier an inflammation of the fallopian tubes and ovaries or adnexitis is treated with medication, the lower the risk of infertility and a chronic course.

Chronic adnexitis is difficult to treat . In many cases, conservative treatment measures can alleviate the symptoms and sometimes even eliminate the chronic inflammation itself. Despite this, many women continue to have trouble conceiving or are prone to ectopic pregnancies (due to permanent adhesions in the fallopian tubes).

In some cases there is complete infertility as a result of chronic inflammation in the abdomen. Gynecologists therefore often recommend that if the desire to have children remains unfulfilled for more than one and a half to two years, they should seek advice from specialists such as reproductive medicine specialists in fertility clinics at an early stage.

Complications and late effects

If adnexitis remains untreated for a long time, this often leads to complications with a severe course and health consequences. In some cases, accumulations of pus ( abscesses ) form. A Douglas abscess may develop . This is an encapsulated focus of pus between the rectum and uterus, with often severe pain during bowel movements.

In addition, acute adnexitis sometimes leads to an abscess between the fallopian tube and the ovary ( tubo-ovarian abscess ), in which the tissue between the fallopian tube and the ovary fuses in an inflamed manner.

As a result, extensive adhesions (brides) form between the uterus, intestines , pelvic wall and ligaments. This can lead to problems in the fallopian tube in catching egg cells from the ovary and transporting them towards the uterus. The result is infertility . With chlamydial infections, the risk of sterility is up to 20 percent.

In some cases, however, fertility is also impaired in another way – namely when a lot of inflammatory secretion forms in the case of acute inflammation of the fallopian tubes or adnexitis, which clogs the fallopian tubes .

Sometimes tubal adhesions in the course of an acute or chronic fallopian tube infection do not impede fertilization, but the onward transport of the egg cell to the uterus: The fertilized egg cell gets stuck on the adhesions and then implants itself directly in the fallopian tube – an ectopic pregnancy ( tubal pregnancy ) is the result .

The adhesions in the abdomen (brides), which sometimes form as a result of adnexitis or other inflammation, later cause a mechanical bowel obstruction ( ileus ) in some women. Doctors refer to this as a so-called bride’s ileus. This is an emergency that requires immediate surgery.

If the germ-containing, inflammatory secretion formed during adnexitis passes into the free abdominal cavity, a dangerous peritonitis ( peritonitis ) develops. It is usually limited to the small pelvis (pelvic peritonitis). If it spreads to the entire peritoneum, doctors refer to this as diffuse peritonitis. This emergency also requires quick medical help.

The germs that are responsible for the pelvic inflammatory disease may spread throughout the body via the bloodstream and thus trigger “ blood poisoning ” ( sepsis ). In some cases, there is a risk of death, which is why immediate emergency medical care is necessary.

All of these severe complications (tubal pregnancy, peritonitis, ileus, peritonitis, sepsis) are medical emergencies in which the emergency call must be called. In most cases, however, these can be prevented by early treatment of the fallopian tube and ovarian inflammation.

In severe cases, conservative treatment is unsuccessful. Then the chronic inflammation of the fallopian tubes and the ovaries can only be controlled by completely removing the fallopian tubes and possibly also the ovaries and the uterus.

How can fallopian tube and ovarian inflammation be prevented?

Acute adnexitis can be prevented by always using a condom during intercourse. In addition to preventing pregnancy, the mechanical contraceptive also prevents infection with pathogens that may trigger abdominal inflammation (such as chlamydia).

If there is an inflammation of the fallopian tubes and/or ovaries, it is important to also treat the sexual partner, otherwise inflammation will always occur.

Appropriate personal hygiene also helps prevent it. The motto here is: Not too much and not too little. Wash your intimate area regularly with clear water. If you want to use washing lotion, make sure that it is pH-neutral and suitable for intimate hygiene.

Conventional soap throws the natural vaginal flora out of balance and thus promotes the spread of pathogens. If these rise above the vagina and uterus, there is a risk of adnexitis. Vaginal douches are also less recommended, as they also promote the development of fallopian tube and ovarian inflammation.

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