A Text-book of Diseases of Women

by Charles B. Penrose

The most pronounced symptom of chronic salpingitis is pain. The pain is referred to one or to both ovarian regions as the disease is unilateral or bilateral. It is due not only to the salpingitis, but to the accompanying ovaritis. The pain is continuous. It is relieved by the recumbent posture, and is increased whenever the woman is upon her feet or is performing any work. The pain is increased by a jolt or sudden movement, by defecation, often by urination and by coitus. The pain during coitus, from direct pressure, is often so great that marital relations are abolished. I have seen a woman with salpingitis who was obliged to take a dose of morphine before every act of defecation. The pain from the jolting of a carriage often renders riding impossible.

The pain is dull and aching in character or sharp and lancinating. It may extend down the anterior aspect of the thighs.

The pain is very much worse at each menstrual period. All the genital structures become congested and swollen at this time, and such phenomena, occurring in the adherent inflamed tubes and ovaries, often cause unbearable pain. The dysmenorrhea in salpingitis is usually very characteristic. It begins several days—sometimes a week—before the bleeding appears. It starts in one or both ovarian regions, and radiates thence throughout the pelvis and down the thighs. It will be remembered that the dysmenorrhea of anteflexion begins only a few hours before the bleeding—that the pain is usually situated in the center of the lower abdomen, in the region of the uterus, is expulsive in character, and is relieved when the bleeding has become well established.

The dysmenorrhea of salpingitis usually lasts throughout the whole of the period.

The pain of salpingitis persists throughout the whole course of the disease. It is common to all forms of salpingitis, and seems to bear no relation to the gross character of the lesions of the tubes. The pain and the dysmenorrhea are often as marked in a case of salpingitis without cystic distention as in a case of large pyosalpinx.

The pain persists after the dangerous stages of the disease have been passed. Relief begins only with the cessation of menstruation, when general atrophy takes place in the genital organs.

The pain of salpingitis is often obvious from the expression and the posture of the woman. She walks with the body slightly flexed forward; she sits down gently upon a chair; she protects herself, by support with the hand, from the jolting of a carriage or a car.

The woman frequently suffers with marked exacerbations of the pain, which occur independently of the menstrual periods, and are caused by leakage from the tube and the resulting local peritonitis. The woman often describes such attacks as attacks of “inflammation of the bowels.” They occur usually during the early stages of the disease. Each attack, if survived, results in a more perfect closure of the ostium abdominale, and diminishes the risk of subsequent attacks. At these times all the symptoms of local peritonitis are present: elevated temperature, rapid pulse, local or general distention, and tenderness. In any case of pyosalpinx or of old chronic salpingitis close questioning of the patient will elicit a history of this kind.

Acute attacks of pain, fever, and other disturbance also occur in cases of chronic salpingitis from acute reinfection of the diseased tube. The disease may have been quiescent for a long time, and yet active reinfection may take place by way of the uterine cavity or by the passage of the colon bacillus through an adherent intestinal wall; or infection may occur through an adherent bladder.

Salpingitis is usually accompanied by menorrhagia. It is impossible to determine how much of this is to be attributed to the tubal disease. There is always an accompanying endometritis which is sufficient to account for it.