Pelvic Inflammatory Disease (PID)

Definition
Pelvic inflammatory disease (PID) is an infection of the female reproductive
organs. It usually occurs when sexually transmitted bacteria spread from your
vagina to your uterus and upper genital tract. Pelvic inflammatory disease
may also develop when bacteria travel up a contraceptive device or when
bacteria are introduced during gynecologic procedures.
Many women who develop pelvic inflammatory disease either experience no
signs or symptoms or dont seek treatment. Pelvic inflammatory disease may
be detected only later when you have trouble getting pregnant or if you
develop chronic pelvic pain.
Pelvic inflammatory disease is important to avoid because it can result in
infertility or complications during pregnancy. Prompt treatment of a sexually
transmitted disease can help prevent PID.

Symptoms
Signs and symptoms of pelvic inflammatory disease may include:

Pain in your lower abdomen and pelvis

Heavy vaginal discharge with an unpleasant odor
Irregular menstrual bleeding
Pain during intercourse
Low back pain

Fever, fatigue, diarrhea or vomiting

Painful or difficult urination
PID may cause only minor signs and symptoms or none at all. Asymptomatic
PID is especially common when the infection is due to chlamydia. The lack of
signs and symptoms increases the likelihood that youll pass chlamydia to
other sexual partners and suffer serious damage to your reproductive organs.
Go the emergency room if you experience the following severe signs and
symptoms of PID:

Severe pain low in your abdomen

Vomiting
Signs of shock, such as fainting
Fever of higher than 101 F

Causes
Unsafe sexual practices that increase your likelihood of acquiring a sexually
transmitted disease (STD) such as unprotected sex with more than one
partner increase your risk of pelvic inflammatory disease. The most
common bacteria that cause PID also cause gonorrhea and chlamydia.
Some forms of contraception may affect your risk of developing pelvic
inflammatory disease. Contraceptive IUDs may increase your risk of PID, but
barrier methods, such as condoms or diaphragms, reduce your risk. Use of
the birth control pill alone offers no protection against acquiring STDs. But the
pill may offer some protection against the development of PID by causing your
body to create thicker cervical mucus, making it more difficult for bacteria to
reach your upper genital tract.
Bacteria may also enter your reproductive tract as a result of an IUD insertion,
childbirth, miscarriage, abortion or removing a small piece of tissue from your
uterine lining for laboratory analysis (endometrial biopsy).

Risk Factors
A number of factors may increase your risk of pelvic inflammatory disease,
including:

Being a sexually active woman younger than 25 years old

Having multiple sexual partners

Using nonbarrier contraceptives consistent use of barrier

methods protects against PID, but may not protect against other
STDs, such as human papillomavirus (HPV) and herpes simplex virus
(HSV)

Having had an IUD inserted recently

Douching regularly, which may flush bacteria higher into your

genital tract and mask symptoms that might otherwise cause you to
seek early treatment

Having a history of pelvic inflammatory disease or any sexually

transmitted disease

When to Seek Medical Advice

See your doctor if you have signs and symptoms of pelvic inflammatory
disease, including:

Pain in your lower abdomen and pelvis

Unusual vaginal discharge with an unpleasant odor
Irregular menstrual bleeding
Pain during intercourse
Low back pain
Fever, fatigue, diarrhea or vomiting
Painful or difficult urination
Genital sores or rash, discharge with an odor, painful urination, or bleeding
between menstrual cycles also can indicate an STD. If these signs and
symptoms appear, stop having sex and see your doctor soon. Prompt
treatment of an STD can help prevent PID.

Test and Diagnosis

Doctors diagnose pelvic inflammatory disease based on signs and symptoms,
a pelvic exam, an analysis of vaginal discharge and cervical cultures.
During the pelvic exam, your doctor uses a cotton swab to take samples from
your vagina and cervix. The samples are sent to a laboratory for analysis to
determine which organism is causing the infection.
To confirm the diagnosis or to determine how widespread the infection is, your
doctor may advise a pelvic laparoscopy. During this procedure, your doctor
inserts a thin, lighted instrument through a small incision in your abdomen to
view your pelvic organs.

Complications
Untreated pelvic inflammatory disease may cause scar tissue and collections
of infected fluid (abscesses) to develop in your fallopian tubes and damage
your reproductive organs. Complications may include:
Ectopic pregnancy. PID is a major cause of tubal (ectopic)
pregnancy. In an ectopic pregnancy, the fertilized egg cant make its
way through the fallopian tube to implant in the uterus. Ectopic
pregnancies can cause massive, life-threatening bleeding and
require emergency surgery.

Infertility. About one in eight women with pelvic inflammatory

disease becomes infertile unable to become pregnant after one
year of unprotected sex. Delaying treatment for PID dramatically
increases your risk of infertility. PID may damage your reproductive
organs and cause infertility.

Chronic pelvic pain. Up to one-half of women with

symptomatic pelvic inflammatory disease develop chronic pelvic
pain that may last for months or years. Scarring in your fallopian
tubes and other pelvic organs can cause pain that commonly occurs
during intercourse, exercise and ovulation.

Treatment and Drugs

Antibiotics are the standard treatment for pelvic inflammatory disease. Your
doctor may prescribe a combination of antibiotics before receiving the results
of your laboratory tests. The antibiotics may be adjusted once your results are
known. Your doctor may also prescribe a medication to relieve your pain and
recommend bed rest.
To prevent reinfection of PID, advise your sexual partner to be examined and
treated. Avoid sexual intercourse until treatment is completed and tests
indicate that the infection has cleared in all partners.

More serious cases

Outpatient treatment is adequate for treating most women with pelvic
inflammatory disease. However, if youre seriously ill, pregnant or HIVpositive, or have not responded to oral medications, you may need

hospitalization. At the hospital, you may receive intravenous (IV) antibiotics,

followed by oral antibiotics.
Surgery is rarely necessary. However, if an abscess ruptures or threatens to
rupture, your doctor may drain it. In addition, surgery may be performed on
women who dont respond to treatment or who have a questionable diagnosis,
such as when one or more of the signs or symptoms of PID are absent. In
these cases, doctors often try antibiotic treatment before surgery, because of
the risks of surgery.

Prevention
Most cases of pelvic inflammatory disease can be prevented by safe sex
practices. Proper use of condoms reduces, but doesnt eliminate, the risk of
contracting an STD. In addition to consistent, careful condom use, STD
prevention is best achieved by mutually monogamous sexual relationships or
abstinence.
If you practice high-risk sexual behaviors, have regular screenings for STDs.
Your doctor can help you determine an appropriate screening schedule.
If you have pelvic inflammatory disease or an STD, advise your partner to be
tested and, if necessary, treated. This can prevent the spread of STDs and
possible recurrence of PID.