bubble_chart Overview

Chronic pelvic connective tissue inflammation is a relatively common gynecological disease, but it is often misdiagnosed as "chronic adnexitis," leading patients to believe they may have lost their fertility. This results in seeking multiple medical consultations and experiencing low mood.

bubble_chart Etiology

The cervical lymphatic pathway directly communicates with the parametrial connective tissue, so chronic pelvic parametritis often occurs secondary to severe chronic cervicitis and is also one of the complications of cervical carcinoma.

This condition may also result from incomplete treatment during the acute stage, allowing pathogens to persist in the lesions. In the acute phase, the inflammation is primarily characterized by edema and congestion. As it progresses to chronic inflammation, fibrous tissue proliferation becomes predominant, gradually transforming the connective tissue into harder scar tissue, sometimes even leading to a "frozen pelvis" state in the pelvic cavity.

Grade I chronic pelvic parametritis may be asymptomatic. As the condition progresses, patients often experience distending pain in the lumbosacral region and/or lower abdomen. The pain may also be caused by sacroiliitis. Dyspareunia is a common symptom due to the lower position of the pelvic connective tissue, making it more susceptible to irritation. Simple pelvic parametritis is an extraperitoneal inflammation and usually does not affect fertility.

During a rectovaginal-abdominal examination, the most common sign is significant thickening of the bilateral uterosacral ligaments, resembling two cord-like structures encircling the rectum bilaterally, accompanied by tenderness. The parametrial tissues (cardinal ligaments) are also often thickened, sometimes more prominently on one side. If the examination is not thorough, the thickened ligaments may be mistaken for uterine adnexa, leading to a misdiagnosis of chronic adnexitis. When the uterosacral or cardinal ligaments become thickened, hardened, and shortened, the uterus may shift, deviate to one side, or have restricted mobility. If frozen pelvis develops, the uterus may become completely fixed.

Since chronic pelvic parametritis often follows chronic cervicitis, active treatment of the latter—including medication, physical therapy, and surgical intervention—should be the primary consideration in managing chronic pelvic parametritis. Otherwise, persistent cervicitis will continue to adversely affect the pelvic connective tissue.

Antibiotic therapy may also provide some benefit. Physical therapy (diathermy) is another common approach but requires long-term adherence. Combining antibiotics with physical therapy yields better results, though antibiotics should not be used indefinitely.

A "good therapeutic outcome" refers to the disappearance or alleviation of symptoms and softening of the pelvic connective tissue. Although this condition does not usually lead to severe consequences, it can be stubborn and prone to recurrence, necessitating long-term follow-up. Additionally, attention should be paid to the possible presence of sacroiliitis.

bubble_chart Clinical Manifestations

Grade I chronic pelvic connective tissue inflammation may be asymptomatic. As the condition progresses, patients often experience distending pain in the lumbosacral region and/or lower abdomen. The pain may be caused by sacroiliitis. Dyspareunia is a common symptom of this condition, as the connective tissue in the pelvis is located relatively low and is easily irritated. Simple pelvic connective tissue inflammation is an extraperitoneal condition, and the patient's fertility is usually unaffected.

During a triple examination, the most commonly observed sign is significant thickening of the bilateral uterosacral ligaments, resembling two cord-like structures encircling both sides of the rectum, accompanied by tenderness. The bilateral parametrial tissues (cardinal ligaments) are also often thickened, though one side may be more pronounced than the other. If the examination is not thorough enough, the thickened ligaments may be mistaken for uterine adnexa, leading to a misdiagnosis of chronic adnexitis. When the uterosacral or cardinal ligaments thicken, harden, and shorten, the uterus may become displaced, deviated to one side, or have restricted movement in the anterior-posterior direction. If a frozen pelvis develops, the uterus may become completely immobile.

Since chronic pelvic connective tissue inflammation often arises secondary to chronic cervicitis, active treatment of the latter—including medication, physical therapy, and surgical intervention—should be the primary consideration in managing chronic pelvic connective tissue inflammation. Otherwise, the persistence of cervicitis will continue to adversely affect the pelvic connective tissue.

Antibiotic therapy may also yield some therapeutic benefits. Physical therapy (diathermy) is another commonly used method, though it requires long-term adherence. Combining antibiotics with physical therapy tends to produce better results, but antibiotics should not be used indefinitely.

A successful treatment outcome refers to the disappearance or alleviation of symptoms and the softening of the pelvic connective tissue. Although this condition does not typically lead to severe consequences for the patient, it can sometimes be stubborn, with symptoms prone to recurrence. Therefore, long-term follow-up and monitoring are necessary, and attention should be paid to the possible presence of sacroiliitis.

bubble_chart Treatment Measures

Since chronic pelvic connective tissue inflammation often occurs secondary to chronic cervicitis, active treatment of the latter—including medication, physical therapy, and surgical intervention—is the primary measure to consider when treating chronic pelvic connective tissue inflammation. Otherwise, the presence of cervicitis will continue to adversely affect the pelvic connective tissue.

The use of antibiotics may also yield certain therapeutic effects. Physical therapy (diathermy) is another commonly employed method, though it requires prolonged and consistent application. Combining antibiotics with physical therapy yields better results, but antibiotics should not be used long-term.

A good therapeutic outcome refers to the disappearance or alleviation of the patient's symptoms and the softening of the pelvic connective tissue. Although this condition does not lead to severe consequences for the patient, it can sometimes be stubborn, with symptoms prone to recurrence. Therefore, long-term follow-up observation is necessary, and attention should be paid to the potential presence of sacroiliitis.