Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is an infection of a woman's reproductive tract (uterus, fallopian tubes, and ovaries) that leads to inflammation and pain in the lower abdomen.
Pelvic inflammatory disease can cause scars to develop that result in infertility, ectopic pregnancy, chronic pelvic pain, abscesses, and other medical problems. Pelvic inflammatory disease is the most common preventable cause of infertility.
Women who have contracted a sexually transmitted infections (chlamydia, gonorrhea) are at greater risk of developing PID. Other potential risk factors include using an IUD and douching which can force bacteria from the vagina into the upper reproductive organs. For this reason, women should avoid douching.
What are the symptoms of pelvic inflammatory disease?
Symptoms of PID can range from mild to severe. The most common symptom is pain in your lower abdomen. Other symptoms include:
- Vaginal discharge that may have an odor
- Painful intercourse
- Painful urination
- Irregular menstrual bleeding
- Pain in the upper right abdomen
Sometimes pelvic inflammatory disease comes on suddenly with extreme pain and fever, especially if it is caused by gonorrhea.
How is pelvic inflammatory disease diagnosed?
Pelvic inflammatory disease can be difficult to diagnose because symptoms can be mild and similar to other diseases. If you think you might have PID, you should get medical care promptly because early treatment can limit long-term complications such as infertility and chronic pelvic pain.
If you have symptoms such as lower abdominal pain, your health care provider will perform a physical exam, including a pelvic (internal) exam, to find out the nature and location of the pain.
70% of chlamydial infections and 50% of gonococcal infections occur in women without causing symptoms and are first found through screening. You should get regular laboratory tests for chlamydia, gonorrhea, urinary tract infection, and if appropriate, pregnancy. Your health care provider may suggest these tests as part of a routine annual exam as well as tests for HIV infection and syphilis.
If necessary, your health care provider may perform additional tests, including ultrasound, endometrial (uterine) biopsy, or laparoscopy to distinguish between pelvic inflammatory disease and other medical problems with similar symptoms.
How is pelvic inflammatory disease treated?
Antibiotics are prescribed to kill the bacteria that may be causing PID. You should begin treatment as soon as your health care provider diagnoses PID because complications of the disease may be prevented with taking antibiotics immediately.
Even if your symptoms go away, you should finish taking all of the medicine. You also should return to your health care provider 2 to 3 days after beginning the medicine to be sure the antibiotics are working.
Your health care provider may recommend going into the hospital to treat your PID if you:
- Are severely ill
- Are pregnant
- Do not respond to or cannot take oral medicine
- Need intravenous (in the vein) antibiotics
- Have an abscess (swelling) in your fallopian tube or ovary
If your symptoms continue or if an abscess does not go away, you may need surgery.
Complications of PID such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.
Many sex partners may be infected with bacteria that cause PID and do not know it because they do not have symptoms. To protect yourself from being re-infected with bacteria that cause PID, you should discuss this with your health care provider.
How can pelvic inflammatory disease be prevented?
The surest way to avoid getting or transmitting sexually transmitted infections (STIs) is to abstain from sex or to be in a long-term, mutually monogamous relationship with a partner who has been tested and isn’t infected. Condoms, when used consistently and correctly, can reduce your risk of getting chlamydia and gonorrhea.
In addition, you can protect yourself from PID by getting treated quickly if you do get an STI.
The most common preventable cause of PID is an untreated STI, mainly chlamydia or gonorrhea.
If you have had chlamydia, you also should be re-tested several months after completing treatment so you can be re-treated, if necessary.
What are the complications of pelvic inflammatory disease?
Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause permanent damage to the female reproductive organs. Infection-causing bacteria can silently invade the fallopian tubes, causing normal tissue to turn into scar tissue. This scar tissue blocks or interrupts the normal movement of eggs into the uterus.
If your fallopian tubes are totally blocked by scar tissue, sperm cannot fertilize an egg and you become infertile. Infertility also can occur if the fallopian tubes are partially blocked or even slightly damaged. About one in five women with PID becomes infertile.
In addition, a partially blocked or slightly damaged fallopian tube may cause a fertilized egg to remain in the fallopian tube. If this fertilized egg begins to grow in the tube as if it were in the uterus, it is called an ectopic or tubal pregnancy. An ectopic pregnancy can rupture the fallopian tube, causing severe pain, internal bleeding, and even death.
Scarring in the fallopian tubes and other pelvic organs can also cause chronic pelvic pain (pain lasting for months or even years). You are more likely to suffer infertility (20% of women), ectopic pregnancy (9%), or chronic pelvic pain (18%) if you have repeated episodes of PID.