CONDITIONS

Pelvic Inflammatory Disease (PID)

What Is Pelvic Inflammatory Disease (PID)

It’s treatable and preventable, yet according to the National Health Institute, 1 million women in the United States get Pelvic Inflammatory Disease (PID) every year – and 1 in 8 of those women will suffer from infertility as a result. PID is a contagious and common infection in a woman’s reproductive organs, most often the result of a Sexually Transmitted Infection (STI). A serious complication of some STIs, PID occurs when certain bacteria – most commonly, chlamydia or gonorrhea – travel upward from a woman’s vagina or cervix into her womb, fallopian tubes, or ovaries. Other infections that are not sexually transmitted can also cause PID; in fact, normal bacteria found in the vagina and on the cervix can sometimes cause PID, but no one is sure why this happens.

About 1 in 8 sexually active girls will have PID before age 20, yet many women who develop it will either experience no symptoms or won’t seek treatment.  PID may be detected only later, when you have trouble getting pregnant or if you develop chronic pelvic pain.

What Causes Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease can be caused by a variety of bacteria, but is most often caused by gonorrhea or chlamydia infections. These bacteria are usually acquired during unprotected sex, and are types of sexually transmitted infections (STIs).  PID occurs when the bacteria makes its way up from a woman’s vagina or cervix and travels to the womb, fallopian tubes, and/or ovaries, and causes an infection.

Less commonly, bacteria may enter your reproductive tract anytime the normal barrier created by the cervix is disturbed, such as during:

  • Childbirth
  • Endometrial biopsy (removing a small piece of your womb lining to test for cancer)
  • Getting an intrauterine device (IUD)
  • Miscarriage
  • Abortion

 

Risk Factors For Pelvic Inflammatory Disease (PID)

According to the National Institute of Health (NIH), you are more likely to get PID if:     

  • You have a male sex partner with gonorrhea or chlamydia.
  • You have sex with many different people.
  • You have sex without a condom
  • You have had an STI in the past.
  • You have recently had PID.
  • You have recently gotten an IUD.
  • You have had sex before age 20.

An additional risk factor is regular douching, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment

Diagnosing Pelvic Inflammatory Disease (PID)

There are no tests specifically for diagnosing PID. Health care providers diagnose pelvic inflammatory disease based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.

Your health care provider may do a pelvic exam to look for:

  • Bleeding from your cervix (the opening to your uterus)
  • Fluid / abnormal discharge coming out of your cervix
  • Pain when your cervix is touched
  • Tenderness in your uterus, fallopian tubes, or ovaries
  • Lumps called abscesses near your ovaries and fallopian tubes

You may have lab tests to check for signs of infection:

  • C-reactive protein (CRP)
  • Erythrocyte sedimentation rate (ESR)
  • WBC count

Other tests may include:

  • A swab taken of your vagina or cervix. This sample will be checked for gonorrhea, chlamydia, or other causes of PID.
  • Pelvic ultrasound or CT scan to see what else may be causing your symptoms. (Appendicitis or pockets of infection around your tubes and ovaries may cause similar symptoms.)
  • Endometrial biopsy. During this procedure, your doctor removes a small piece of your uterine lining (endometrium) for testing.
  • During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.
  • Pregnancy test

Your health care provider will often have you start taking antibiotics while waiting for your test results.

 

Symptoms of Pelvic Inflammatory Disease (PID)

Symptoms with PID can vary widely – some women may have very mild symptoms, while still others may experience no symptoms. For this reason, episodes of PID can go unrecognized by women and their health care providers.

Pelvic inflammatory disease is often difficult to identify because the symptoms are similar to those of other conditions, such as appendicitis, urinary tract infections, ovarian cysts, and endometriosis.

When present, the most common symptoms of PID are:

  • Pain or tenderness in your lower abdomen (lower belly or lower back) is the most common symptom
  • Mild pelvic pain or tenderness
  • Chills
  • Being very tired
  • Increased vaginal discharge
  • Irregular menstrual bleeding or unusual spotting
  • Loss of appetite
  • Nausea
  • Vomiting
  • Skipping your period
  • Fever (100.4°F or higher)
  • Pain with intercourse
  • Painful and / or unusually frequent urination
  • Uterine tenderness (along with endometriosis)
  • Adnexal tenderness (along with salpingitis)
  • Cervical motion tenderness
  • Inflammation

Prognosis

More than 100,000 women become infertile each year because of PID. Additionally, many ectopic pregnancies that occur are the result of complications from PID.

The risk of developing short and long-term complications from PID depends upon the severity and number of episodes of PID, which is why prompt and appropriate treatment is so important.  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 from PID include the following:

  • Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. In an ectopic pregnancy, the fertilized egg can’t make its way through the fallopian tube to implant in the uterus. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency surgery.
  • Tubo-ovarian abscess (TOA). This serious short-term complication of PID is characterized by an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs. Diagnosis necessitates an initial hospital admission.
  • Tubal factor infertility. a disorder in which the fallopian tubes are blocked or damaged.
  • Chronic pelvic pain. PID can cause pelvic pain that may last for months or years.
  • Scarring in your fallopian tubes and other pelvic organs. this can cause pain during intercourse and ovulation.
  • The more times you’ve had PID, the greater your risk of infertility. Delaying treatment for PID also dramatically increases your risk of infertility.

Coping With

Often, a diagnosis of PID comes along with the news that you have a sexually transmitted Infection (STI), which can be shocking and upsetting. The important thing, though, is to make sure you get treatment right away. And keep in mind that STIs are a very common occurrence – you are not alone!

Over one in two Americans will contract an STD/STI at some point in their lifetimes. According to the US Department of Health and Human Services, 19 million new sexually transmitted infections are thought to occur each year in the United States. These infections affect men and women of all backgrounds and economic levels, but women as a group are severely affected by STIs, as they have more frequent and more serious health problems from STIs than men.

Complications

There are no tests specifically for diagnosing PID. Health care providers diagnose pelvic inflammatory disease based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.

 

Prevention

It’s important to get regular testing and prompt treatment for STIs.  You can reduce your risk of PID by practicing safe sex, but know that the only absolute way to prevent an STI is to not have sex (abstinence).  However…

You can reduce your risk of STIs by practicing safe sex:

  • Having a sexual relationship with only one person.
  • Ensuring that you and your sexual partners get tested for STIs before starting a sexual relationship.
  • Using a condom every time you have sex.

To reduce your reduce your risk of PID: 

  • Practice safe sex, as above.
  • Talk to your doctor about contraception. Some forms of contraception may affect your risk of developing pelvic inflammatory disease; for example, a contraceptive intrauterine device (IUD) may increase your risk of PID temporarily for the first few weeks after insertion, but a barrier method, such as a condom, reduces your risk. Use of a birth control pill alone offers no protection against acquiring STIs, 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 uterus, fallopian tubes or ovaries. It’s still important, however, to use a condom every time you have sex.
  • Get regular STI screening exams. Early treatment of an STI gives you the best chance of avoiding pelvic inflammatory disease.
  • If you are a new couple, get tested before starting to have sex. Testing can detect infections that aren’t causing symptoms.
  • If you are a sexually active woman age 25 or younger, get screened each year for chlamydia and gonorrhea.
  • All women with new sexual partners or multiple partners should also be screened.
  • Don’t douche. Douching upsets the balance of bacteria in your vagina.
  • Employ good hygiene habits. Wipe from front to back after urinating or having a bowel movement to avoid introducing bacteria from your colon into the vagina.

Medication And Treatment

If you have mild PID:     

  • It’s likely that your health care provider will give you a shot containing an antibiotic.
  • You will receive a prescription for antibiotic pills to take for up to 2 weeks.
  • You will need to follow up closely with your health care provider – usually, your doctor will request a follow-up visit in three days to make sure the treatment is working.

If you have more severe PID:     

  • A hospital stay might be necessary
  • You might be given intravenous antibiotics (IV)
  • You may later be given antibiotic pills to take by mouth.
  • Surgery is rarely necessary. However, if an abscess ruptures or threatens to rupture, your doctor may drain it. Surgery may be performed if you don’t respond to antibiotic treatment, or if you have a questionable diagnosis (such as when one or more of the signs or symptoms of PID are absent).

Treatment for your partner: To prevent getting re-infected with an STI (which can then cause another bout of PID,) it’s important to ask your sexual partner or partners to be examined and treated. Your partners can be infected and not have any noticeable symptoms. 

If you are being treated for PID, Planned Parenthood gives this important advice:

  • Take all of the prescribed medicine. Even if the symptoms go away, the infection may still be in your body until the treatment is complete.
  • Take good care of yourself.
  • Rest in bed. You need several days of bed rest to treat a serious infection.
  • Drink lots of fluids, and eat a healthy diet.
  • Do not douche or use tampons.
  • You may take aspirin, ibuprofen (like Advil), or acetaminophen (like Tylenol) for pain. You may also put a heating pad on your stomach.
  • Tell your partner(s) that you have an infection. Any recent partner will need to get checked and get medicine — even if feeling fine. If your partner(s) are not treated for any possible infections, such as chlamydia or gonorrhea, you can get PID again.
  • Do not have sex until you and your partner(s) have finished all the medicine, have been examined, and know that treatment is complete.
  • Keep your medical appointments to be sure you are better.

When To Contact A Doctor

If you think that you may have PID, see a doctor right away. Early diagnosis and treatment is key to reducing your risk of complications including infertility and long-term pain.

IMPORTANT: If you think you may have an ectopic pregnancy and can’t reach your health care provider, go to a hospital emergency room right away.

Questions For A Doctor

Before you go see your doctor, it’s good to make a list of any symptoms you’re experiencing, including that might even seem unrelated to the reason you made the appointment.  Also, make a list of all medications, vitamins or supplements that you’re taking.

Then, write down questions to ask your doctor, including:

  • What kinds of tests do I need?
  • Is this a sexually transmitted infection (STI)? Should my partner be tested or treated?
  • Do I need to stop having sex during treatment? How long should I wait?
  • How can I prevent future episodes of PID?
  • Will this affect my ability to become pregnant?
  • Is there a generic alternative to the medicine you’re prescribing me?
  • Can I be treated at home? Or will I need to go to a hospital?
  • Do you have any printed materials that I can take with me? What websites do you recommend?
  • Do I need to come back for a follow-up visit?

Your doctor is likely to ask you a number of questions, such as:     

  • Do you have a new sexual partner or multiple partners?
  • Do you always use condoms?
  • When did you first begin experiencing symptoms?
  • What are your symptoms?
  • Are you experiencing any pelvic pain?
  • How severe are your symptoms?

Resources

For information about STIs and STDs (including prevention and treatment), visit:

Planned Parenthood

WomensHealth.gov