Pelvic inflammatory disease (PID) is an inflammatory disorder of the female upper genital tract that can include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Sexually transmitted organisms such as Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum cause many cases of PID. However, organisms that comprise the normal vaginal flora (Cardnerella vaginalis, Haemophilus influenzae, Streptococcus agalactiae, enteric gram-negative rods) have also been implicated.
Pelvic inflammatory disease has a number of severe long-term sequelae. Of women who develop PID, 20% develop infertility, 18% suffer from chronic pelvic pain, and 9% will have an ectopic pregnancy. Because of these devastating sequelae, the CDC has cautioned clinicians to maintain a low threshold for its diagnosis and treatment, and this should be especially true among sexually active young women. Preventing these sequelae is the reason that C. trachomatis screening in asymptomatic women has been implemented, as C. trachomatis causes about 40% of PID cases.

Risk Factors
A number of risk factors for PID have been identified and should be recognized by practitioners:
– Age less than 35 years
– Non-barrier contraception
– New, multiple, or symptomatic sexual partners
– History of PID

Clinical Findings
Bilateral lower abdominal pain is the most typical symptom in PID. The pain may be mild and is sometimes present only during intercourse or menses. Other symptoms include vaginal discharge, fever, and dysuria. On examination, patients with PID may appear well or toxic. If abdominal tenderness is present, it is typically diffuse. Fever and vaginal discharge are important signs to look for.


Having a new experience can enliven you for a long while afterward and even provide you with a new perspective that lasts a lifetime. Simply getting something new, on the other hand, frequently ceases to be exciting after about a week. Then you realize that this new possession isn’t doing all that much for you and that you’ll now have to clean and maintain it perpetually. What’s more, if you have been in the habit of getting new things, you may not even have a place to put it.
A lot of people have a dirty little secret—a dirty big secret, actually. While at first glance their houses may look uncluttered, if you go into their basements or garages, you see the material overflow of their lives, and it’s astounding. There’s a floor-to-ceiling collection of toys, appliances, clothing, kitchen equipment, knickknacks, games, and gadgets that makes Macy’s basement look understocked by comparison. How much of this stuff was bought because the people, who were dissatisfied with their lives, really needed new experiences but went out and got new possessions instead?
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How much of your life is spent maintaining and guarding possessions? What do they mean to you? Can you see yourself without them? Picture yourself without one-third of your possessions. Without half of them. Without three-quarters of them. Mentally choose which ones you might jettison. How do these images make you feel?
When you were a young child, possessions weren’t viewed as permanent but were used to explore, experience, and let go of. Your joy was in using and sharing more than in owning. Once we become adults, though, we don’t want anyone else to touch our things. One floor in our office building is only for the president, the executive vice president, and the executive secretary. Everyone else is kept out. But the president, the executive vice president, and the executive secretary may not be as well off as you might imagine. They may get their identities from their titles and from the fact that they have their own floor—but they may not be any happier for it, or know who they really are.
What happens when you cease to base your identity on what you have? You find other things more meaningful, things you can’t possess to give you happiness—like a sunset, a meaningful conversation with a friend. Without so many permanent possessions to keep you locked in to your old identity, you’re freer to experiment with new jobs, new activities, new environments for living, new people. I truly believe that unless you are able to separate yourself from unnecessary possessions, you will never find true pleasure or see the beauty in this world.
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We work toward making our lives comfortable. Comforts provide a sense of security. But they also prevent us from trying anything new. We become afraid to quit our jobs and find new work, change relationships,  or even change the way we eat,  dress, or comb our hair. New situations create discomfort. We have no way of predicting how we are going to feel and what is going to happen to us. Comfort also creates complacency. Complacency stops the growth process. It prevents us from asking questions that are critical to growth and improvement.
Look at what happens to so many of us in the urban environment. People tend to find comfort in their apartments and in the things they buy, but not with other people. They forget how to communicate with each other. I gave a lecture on making new friends during which I asked people to turn to the person next to them and say hello to someone new. Until I made that request, no one had asked anyone else around them a single question. Imagine that—a lecture on friendship and they were afraid to say hello to someone next to them! They needed my permission and encouragement; their established comfort level wouldn’t allow them to risk talking to someone new on their own.
It is important to challenge yourself by pushing through discomfort. This helps you to expand and grow. Then what was once uncomfortable becomes completely comfortable. Suddenly you will find that you can make decisions, make changes, and let go of old notions that no longer serve you. As you get rid of the old you can allow in the new. You can meet new people and do things you never thought you could do. You are able to say things you wouldn’t have said before and eat foods you wouldn’t have eaten. These are just a few of the wonderful things that can happen when you step outside of your comfort zone.
Weight Loss