How to treat endometriosis and pelvic inflammatory disease

Patient's question:

Married for 1 year, always using contraception, not pregnant
2 months ago, experienced itching in the genital area and excessive discharge. After examination and tests, diagnosed with bacterial vaginosis, moderate cervical inflammation (via cervical TCT), and treated with vaginal medication. Symptoms disappeared, but lower left abdominal pain persisted.
10 days later, visited another hospital for examination, where it was suspected to be endometriosis and pelvic inflammation, with possible endometritis (no ultrasound or other tests performed). Prescribed broad-spectrum antibiotics to be taken during the menstrual period.
Currently, still experiencing mild, cramping-like pain in the lower left abdomen, sometimes with pain on the right side as well. The pain on the left is approximately 5 cm below the navel.

Doctor's answer:

Hello: Based on the situation you described, the several scenarios you mentioned are all possible. Therefore, it is recommended that you actively seek detailed medical examinations at the hospital for confirmation and then receive active treatment! The main symptoms of acute endometritis include fever, lower abdominal pain, increased vaginal discharge, which may sometimes be bloody or have a foul odor. The uterus may be slightly enlarged and tender to touch. Chronic cases also present similarly, and may also include excessive menstrual bleeding, lower abdominal pain, and significant lumbosacral discomfort.
During treatment, in addition to the primary use of antibiotics, it is necessary to remove obvious triggers, such as removing an intrauterine device, clearing residual placental tissue or endometrial polyps in the uterine cavity. If there is an endometrial submucosal fibroid or endometrial cancer, appropriate treatment should be administered based on the situation. In cases of uterine cavity abscess, the cervical os should be dilated to promote pus drainage. After the inflammation is controlled, a diagnostic (D&C) should be performed to rule out the presence of cancer. For chronic cases, physical therapy may sometimes be considered.
During acute endometritis, sexual activity must be avoided, as it can easily lead to further spread of the inflammation. Additionally, due to increased vaginal discharge, abdominal pain, lower back pain, and a sense of heaviness, the female's interest in sex may decline and become unenjoyable. Even after the inflammation is controlled, resuming sexual activity should not involve excessive frequency to prevent pelvic congestion and a weakened immune response, which could lead to recurrence. For chronic cases, due to frequent lower back and back pain, sexual activity may exacerbate symptoms, increase vaginal discharge, worsen abdominal pain, and lumbosacral discomfort. Sexual activity should not be overly frequent, and even if intercourse is forced, it may lack pleasure and climax. Alternatively, even if pleasure and climax are experienced during intercourse, post-coital pelvic congestion may cause symptoms to reappear or worsen. In cases where the above symptoms occur after sexual activity, antibiotics should be used for treatment.