Pelvic Inflammatory Disease in Virgin Women With Tubo-ovarian Abscess: A Single-Center Experience and Literature Review

Abstract

Study Objective: To evaluate the incidence of pelvic inflammatory disease (PID) in virgin women and investigate the clinical characteristics of the patients. Design: Retrospective chart review and literature review. Setting: Tertiary academic center. Participants: Virgin women who were confirmed to have PID via surgery from 2002 to 2014. Interventions: None. Main Outcome Measures: The evaluation of medicosurgical history, clinical progress, surgical record, and pathologic reports. Results: Of 122 patients diagnosed with PID via surgery, 5 women were virgins (4.1%). The median age was 21 years (range, 14-24 years), and all patients presented with abdominal pain. The median diameter of the pelvic abscess pocket on preoperative imaging was 4.5 cm (range, 2.6-15 cm). Only 1 case was preoperatively diagnosed as a tubo-ovarian abscess; the others were expected to be benign ovarian tumors, such as endometrioma and dermoid cysts. No possible source of infection was identified for any patient, except 1 who had a history of an appendectomy because of a ruptured appendix. The results of the histopathological analysis of the excisional biopsy performed during surgery in 4 cases were consistent with acute suppurative inflammation. After postoperative antibiotic use, the conditions of all patients stabilized, and they were discharged from the hospital on median postoperative day 9. Conclusion: PID in virgin women is rare, but it should be considered in all women with abdominal pain, regardless of sexual history.