I recently miscarried during my 11th week of pregnancy and had to have a D&C. It has been almost three weeks, and I am worried about PID. During my check-up after the D&C my lower abdomen was tender. Sometimes when I stretch upward I have a pain in my left side. How can you tell if you have PID? Does it become more painful as time passes? I am 30 and only have one child, and I do not want to lose my chance to have more.

J.M.

First, my condolences on your loss.

PID, or pelvic inflammatory disease, is an infection in the uterus and tubes. It may follow surgical procedures such as a D&C, or it may be the consequence of an untreated sexually transmitted disease. PID can damage the fallopian tubes or lead to scar tissue formation, either of which can lead to future infertility and increase the chance of tubal pregnancy. Mild cases of PID cause pelvic pain and a low-grade fever and are usually treated by oral antibiotics. More severe cases are associated with severe pain, high fevers, and often nausea, vomiting and diarrhea; these cases require intravenous antibiotics and, sometimes, surgery. The most severe cases necessitate an immediate hysterectomy to get rid of the raging infection.

Some tenderness after a D&C is not unusual, but it should not have made you jump off the table when the doctor did the exam. The pain you are having now on the left may be due to an ovarian cyst or to scar tissue -- or it may just be a muscular pain. A cyst in early pregnancy is actually normal; it is called a corpus luteum and it produces the progesterone that is necessary to keep a pregnancy going in the first several weeks.

If you were extremely tender, or if you are still sore and it is not improving, you should see your gynecologist again. If you are having a foul vaginal discharge, you should make an appointment to be seen as soon as possible. While PID often is not associated with a discharge, a heavy malodorous discharge after surgery must be investigated right away.