European Stars and Stripes (Newspaper) - November 20, 1990, Darmstadt, Hesse                                By Philip j. Hilts new York times. Pelvic inflammatory disease an infection of a woman a fallopian tubes or uterus strikes Many More women than previously believed and now must be counted As the most important sexually transmitted disease affecting american women excepting Only aids Public health officials say. Often women learn they Are infected Only when raging infections Force them to undergo hysterectomies or other gynaecological surgery in addition half the cases go untreated experts say because the disease is not recognized until it has destroyed a woman s fallopian tubes. Such scarring has caused hundreds of thousands of cases of infertility and a rapidly rising number of ectopic pregnancies in which the developing embryo is blocked from the uterus a condition that can Lead to Haemorrhage and death. A panel of experts who met recently to review data about the disease has recommended that the centers for disease control Institute new programs including nationwide screenings research on the causes and course of the disease and wider efforts to educate doctors about How to handle it. The experts urged More research to determine whether douching contributes to complications of the disease. Pid is caused by several bacteria chiefly gon Coccus and chlamydia. Most of the disease occurs among women under the age of 25 who Are sexually Active those with gonorrhoea a reportable disease Are concentrated among the poor but chlamydia which is not reportable appears to Cut across income lines. It is known that one half to two thirds of the cases Are transmitted sexually. The remainder Are controversial because it is not certain what organisms Are involved. One study that looked at 60,000 cases of pid in the United states found that relatively few of the women s partners were treated. Because some of the women had More than one sexual partner at risk the number of men by Natalie Angier new York times it was not so very Long ago that people would discuss their sexual woes their family strife even that most intimate of topics their salaries before they would confess to suffering from urinary incontinence. But a series of new studies that underscore the prevalence of the disorder combined with the phenomenal response generated by letters to newspaper columnists has swept the subject into the open much to the Relief of the millions of americans who Long believed they were the Only adults who occasionally lost control of their bladders and at the same time that people Are More willing to talk about incontinence doctors say the prospects for successfully treating the disorder have never been greater. New devices for strengthening the Pelvic Muscles that control urination As Well As belter biofeedback techniques can help those who suffer from mild incontinence while recent advances in non surgical methods to repair damaged bladders and medications to ease bladder spasms offer real Hope for those with More severe forms of the disorder. A what s really disturbing is that half of All people with incontinence done to get help because they think its unbeatable Quot said or. Kathryn l. Burgio a research assistant professor of Medicine and behavioural psychologist at the University of Pittsburgh school of Medicine. Quot but with the treatments available today nine out of 10 can expect significant improvement or a cure Quot the National institutes of health estimates that at least 10 million americans Are stricken by urinary incontinence extreme enough to Cost $10.3 billion annually to manage the problem. But the number of people with incontinence May be far larger than that depending on where one draws the line Between Normal leakage and True mortifying incontinence. Or. John . Delancey assistant professor of Pelvic disease a silent epidemic fallopian tube most frequent a Ite of ectopic pregnancies ovary uterus an often silent threat to reproductive organs cervix the uterus and the fallopian tubes which carry eggs from the ovaries Are normally sterile. Bacteria sometimes get past mucus at the Mouth of the cervix to infect these inner reproductive organs often with no symptoms. Scarring can Block the fallopian lubes preventing Conception or keep an embryo from the uterus so that an ectopic pregnancy occurs in the fallopian tubes. Not treated should have been More than 60,000. In fact Only 29,000 were treated. Quot obstetrics and gynaecology have too narrow a focus Quot said or. David Grimes a gynaecologist at the University of Southern California. Quot we do not generally see men until we treat men and women As a couple when Thev a i infertile. But that s after the cow is out of the barn w should be working on preventing infertility More than treating  infections were associated with some Ludo snob j sold but More recent models Are considered much about one in seven women of reproductive an u already had pid about half of All adult women pm had it by the end of the next decade and 500 Oon a million women will develop it each year said or miss Wasserheit chief of the sexually transmitted disea3 Branch at the National Institute of allergy and infection dl&63s6s. I but recently researchers have realized that there my be in addition a silent epidemic of pid that is equal Large and perhaps causing More damage and death f the reported infection Sas evidence experts cite Large increases in Trenum of american women with massive scarring of the Faw  Lead from the ovaries to the uterus half of s cases of ectopic pregnancy Are caused by Pio and i ectopic pregnancies have shot upward. In 1970 there were 18,000 tubal pregnancies but by 1986 there Werf 84,000, according to the cd a i from 15 to 30 percent of infertility or about 100 of to 150,000 women per year a results from neglected cases of pid. The number also appears to be rising Al to doctors to treat the disease have risen from half a f million in 1966 to about 1.7 million in 1986, according cd estimates. The disease will Cost the nation $3,5 billion in 1990, the centers say despite the very High incidence its diagnosis is St difficult for both medical and social reasons. Quot it is not a popular thing to treat Quot said or. Harol Kaminzky director of practice activities at the Amend College of obstetrics and gynaecology. Quot patients done like to admit they have it Quot he said. I even if they do the men who passed the disease Tol women often do not get treated. A most men who Are to consorts of women who get this kind of disease Aren t aching to come in Quot he  bladder disorder obstetrics and gynaecology at the University of Michigan medical school in Ann Arbor said virtually All women at some Point in their lives experience some degree of involuntary leakage. Women Are far More prone to the problem than men for a number of reasons. Childbirth exerts a heavy toil on the bladder and the sphincter muscle that controls the urethra the opening to the bladder. For another men Are equipped with a second sphincter muscle inside the Penis that further waylay the possibility of an undesirable passage of urine during ejaculation. Indeed so Well protected is the male urogenital system against accidental trickling that men fall prey to diseases of urine blockage like kidney stones. Surveying a group of 326 gynaecology patients who averaged 38 years of age Delancey found that 47 percent leaked minor amounts on a regular basis in such everyday situations As laughing sneezing coughing or exercising. So pervasive is the problem he said that in the United states 50 percent of All sanitary products Are sold not for menstruation but for incontinence. Even severe incontinence which doctors often define As uncontrollable and socially embarrassing leakage at least six times a year is remarkably prevalent again particularly among women who have had children. Physicians estimate that 10 to 15 percent of women from 35 to 50 years old suffer from severe incontinence the problem for women mounts rapidly with age As the loss of female hormones after menopause leads to a thinning and weakening of the urethral lining that is supposed to keep the bidder closed except during urination. Older men Are also likelier to become incontinent As result of prostate disease and neurological disorders Lily alzheimer a. Urinary incontinence is among the most frequently cd reasons when people place elderly relatives in nursing Homes. Despite the magnitude of the disorder Many victims have had few places to turn for information until recent of Burgio who with k. Lynette Pearce a registered Nura and or. Angelo j. Lucco wrote a Book called staying do a practical guide to bladder control said that she and her co authors were rejected by 50 publishers before Johns Hopkins press accepted the manuscript. The first 15,000 copies of the 100-Page Book were published at $12.95 each last summer. But initial Atten to sell and publicize the Book failed. Talk show hosts we not interested and commercial Book stores shunned it Quot Many people were not convinced its an important problem Quot said Burgio Quot Book buyers responded with chuckling rather than  but the laughter ceased when the Book was mentioned in an Ann Landers column in september. Within several Days Johns Hopkins press had been flooded by 20,000 letters. Since its initial publication run 50,000 More copies 0 staying dry have been printed and a new edition has been ordered. A a it a the biggest Selling Book in such a Short period time that this press has Ever had Quot said Ghita Levine spokeswoman for the press. Other people in the incontinence business report similar response to their specially Quot when i go to cocktail parties and people hear i be written a Book about incontinence there s an out Pou of confessions Quot said Rebecca Chalker author of overcoming bladder disorders which was publisher Harper amp Row in june. Quot the last taboo has been Brok Page 16 a the stars and stripes tuesday november 20,1990