Pelvic inflammatory disease, commonly called PID, is an infection of the female reproductive organs. PID is one of the most serious complications of a sexually transmitted disease in women: It can lead to irreversible damage to the uterus, ovaries, fallopian tubes, or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.
How Common Is Pelvic Inflammatory Disease?
Each year, more than 1 million women in the U.S. experience an episode of PID. As a result of PID, more than 100,000 women become infertile each year. In addition, a large proportion of the 100,000 ectopic (tubal) pregnancies that occur each year can be linked to PID. The rate of infection is highest among teenagers.
What Causes Pelvic Inflammatory Disease?
Normally, the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to a sexually transmitted disease -- such as gonorrhea and/or chlamydia -- the cervix itself becomes infected and less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract. Untreated gonorrhea and chlamydia cause about 90% of all cases of PID. Other causes include abortion, childbirth, and pelvic procedures.
What Are the Symptoms of Pelvic Inflammatory Disease?
The symptoms of PID can vary, but may include the following:
What Puts a Person at Risk for Pelvic Inflammatory Disease?
There are several things which would put a woman at risk for PID, including:
- Women with sexually transmitted diseases -- especially gonorrhea and chlamydia -- are at greater risk for developing PID.
- Women who have had a prior episode of PID are at higher risk for another episode.
- Sexually active teenagers are more likely to develop PID than are older women.
- Women with many sexual partners are at greater risk for sexually transmitted diseases (STDs) and PID.
Some studies suggest that douching may contribute to PID. Douching may push bacteria into the upper genital tract and may mask the discharge that could alert a woman to seek medical attention.
How Is Pelvic Inflammatory Disease Diagnosed?
Your doctor will begin with a detailed history of your general health and sexual activity. He or she will perform a pelvic exam to check the health of your reproductive organs, and look for evidence of gonorrhea and chlamydia infection. Your doctor may find the abnormal cervical discharge and tenderness of the cervix, fallopian tubes and cervix on examination. This discharge will be tested to determine the cause of the infection, including cultures for gonorrhea and chlamydia.
If your doctor suspects PID, he or she may order other tests, including:
- Blood tests to analyze blood for evidence of infection.
- Ultrasound (sonogram) to view the reproductive organs.
Other tests less commonly performed include:
- Endometrial biopsy, a procedure in which a small sample of tissue from the lining of the uterus (endometrium) is removed for evaluation and testing.
- Laparoscopy, a procedure during which a thin, lighted instrument (laparoscope) is inserted through a small cut in the lower abdomen to allow the doctor to examine the internal reproductive organs.
What Is the Treatment for PID?
If the findings of your exam or tests suggest PID, treatment is started immediately.
Antibiotics. The initial treatment for mild cases of PID usually consists of one or more antibiotic medications taken by mouth. More significant cases can be treated with a combination of intravenous and oral antibiotics. If treatment is not effective, if you cannot take antibiotics by mouth, or if the infection is severe, you may need to be hospitalized to receive medication intravenously (directly into a vein).
If you are diagnosed with PID, your sexual partner(s) also must be treated even if they do not have any symptoms. Otherwise, the infection will likely recur when you have sex again.
- Surgery. When PID causes an abscess (when the inflamed tissue forms a collection of pus), antibiotics are no longer as effective. Surgery is often needed to remove the abscesses (or the organ with the abscess) to prevent them from rupturing and causing widespread infection throughout the pelvis and abdomen. Depending on the conditions, this may be done with a laparoscope (a thin, lighted instrument) or with a procedure in which the doctor opens the abdomen to view the internal organs (laparotomy). Both techniques are major surgical procedures and are performed under general anesthesia (you are put to sleep).
If abscesses have formed on the uterus or ovaries, your doctor may recommend hysterectomy (removal of the uterus) or oophorectomy (removal of the ovaries).
What Problems Could Pelvic Inflammatory Disease Cause?
Recurrent episodes of PID can result in scarring of the fallopian tubes, which can lead to infertility, ectopic (tubal) pregnancy, or chronic pelvic pain. Infertility occurs in about one in eight women who have PID.
Can Pelvic Inflammatory Disease Be Prevented?
PID is completely preventable. The number one cause of PID is untreated STDs (also called STIs, sexually transmitted infections). Steps you can take to prevent PID include:
- Avoid multiple sexual partners.
- Use barrier methods of birth control (condoms and/or a diaphragm) and spermicides for every single act of intercourse -- even if you use birth control pills.
- Avoid IUDs if you have multiple sexual partners.
- Seek treatment immediately if you notice signs of PID or any sexually transmitted disease, including unusual vaginal discharge, pelvic pain, or bleeding between periods.
- Have regular gynecologic check-ups and screenings since many cervical infections can be identified and treated before they spread to the internal reproductive organs.