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Pelvic inflammatory disease (PID)

Overview

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, fallopian tubes or ovaries.

Pelvic inflammatory disease often causes no signs or symptoms. As a result, you might not realize you have the condition and get needed treatment. The condition might be detected later if you have trouble getting pregnant or if you develop chronic pelvic pain.

Pelvic inflammatory disease

Pelvic inflammatory disease is an infection of the fallopian tubes, ovaries, uterus and cervix. 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.

Symptoms

Signs and symptoms of pelvic inflammatory disease might include:

  • Pain in your lower abdomen and pelvis
  • Heavy vaginal discharge with an unpleasant odor
  • Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
  • Pain or bleeding during intercourse
  • Fever, sometimes with chills
  • Painful or difficult urination

PID might cause only mild signs and symptoms or none at all. When severe, PID might cause fever, chills, severe lower abdominal or pelvic pain — especially during a pelvic exam — and bowel discomfort.

When to see a doctor

See your doctor or seek urgent medical care if you experience:

  • Severe pain low in your abdomen
  • Nausea and vomiting, with an inability to keep anything down
  • Fever, with a temperature higher than 101 F (38.3 C)
  • Foul vaginal discharge

If your signs and symptoms persist but aren't severe, see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms occur, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

Causes

Many types of bacteria can cause PID, but gonorrhea or chlamydia infections are the most common. These bacteria are usually acquired during unprotected sex.

Less commonly, bacteria can enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen after childbirth, miscarriage or abortion.

Risk factors

A number of factors might increase your risk of pelvic inflammatory disease, including:

  • Being a sexually active woman younger than 25 years old
  • Having multiple sexual partners
  • Being in a sexual relationship with a person who has more than one sex partner
  • Having sex without a condom
  • Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms
  • Having a history of pelvic inflammatory disease or a sexually transmitted infection

Most experts now agree that having an intrauterine device (IUD) inserted does not increase the risk of pelvic inflammatory disease. Any potential risk is generally within the first three weeks after insertion.

Complications

Untreated pelvic inflammatory disease might cause scar tissue. You might also develop collections of infected fluid (abscesses) in your fallopian tubes, which could damage your reproductive organs.

Other complications might include:

  • Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. In an ectopic pregnancy, the scar tissue from PID prevents the fertilized egg from making its way through the fallopian tube to implant in the uterus. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency medical attention.
  • Infertility. PID might damage your reproductive organs and cause infertility — the inability to become pregnant. The more times you've had PID, the greater your risk of infertility. Delaying treatment for PID also dramatically increases your risk of infertility.
  • Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that might last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.
  • Tubo-ovarian abscess. PID might cause an abscess — a collection of pus — to form in your uterine tube and ovaries. If left untreated, you could develop a life-threatening infection.

Diagnosis

Doctors diagnose pelvic inflammatory disease based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.

During the pelvic exam, your doctor will first check your pelvic region for signs and symptoms of PID. Your doctor might then use cotton swabs to take samples from your vagina and cervix. The samples will be analyzed at a lab to determine the organism that's causing the infection.

To confirm the diagnosis or to determine how widespread the infection is, your doctor might recommend other tests, such as:

  • Blood and urine tests. These tests will measure your white blood cell count, which might indicate an infection, and markers that suggest inflammation. Your doctor also might recommend tests for HIV and sexually transmitted infections, which are sometimes associated with PID.
  • Ultrasound. This test uses sound waves to create images of your reproductive organs.
  • Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Treatment

Treatments for pelvic inflammatory disease include:

  • Antibiotics. Your doctor will prescribe a combination of antibiotics to start immediately. After receiving your lab test results, your doctor might adjust your prescription to better match what's causing the infection. You will likely follow up with your doctor after three days to make sure the treatment is working.

    Be sure to take all of your medication, even if you start to feel better after a few days. Antibiotic treatment can help prevent serious complications but can't reverse any damage.

  • Treatment for your partner. To prevent reinfection with an STI, your sexual partner or partners should be examined and treated. Infected partners might not have any noticeable symptoms.
  • Temporary abstinence. Avoid sexual intercourse until treatment is completed and tests indicate that the infection has cleared in all partners.

Most women with pelvic inflammatory disease just need outpatient treatment. However, if you're seriously ill, pregnant or haven't responded to oral medications, you might need hospitalization. You might receive intravenous antibiotics, followed by antibiotics you take by mouth.

Surgery is rarely necessary. However, if an abscess ruptures or threatens to rupture, your doctor might drain it. You also might need surgery if you don't respond to antibiotic treatment or have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.

Preparing for an appointment

If you have signs or symptoms of pelvic inflammatory disease, make an appointment to see your doctor or other health care provider.

Here's some information on what you can do to get ready and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
  • Write down any symptoms you're experiencing, including any that might seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Write down questions to ask your doctor.

Some basic questions to ask include:

  • What kinds of tests do I need?
  • Is this a sexually transmitted infection?
  • 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 pelvic inflammatory disease?
  • 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?

What to expect from your doctor

Examples of questions your doctor may ask, include:

  • 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?

Coping and support

Many women are diagnosed with PID along with a sexually transmitted infection. Finding out that you have an STI can be traumatic. Take steps immediately to get treated and to prevent reinfection.

If you've experienced more than one episode of pelvic inflammatory disease, you're at greater risk of infertility. If you've been trying to become pregnant without success, make an appointment with your doctor for an infertility evaluation.

Your doctor or a reproductive health specialist might do tests to determine whether or not your history of pelvic inflammatory disease is causing the problem.

Prevention

To reduce your risk of pelvic inflammatory disease:

  • Practice safe sex. Use condoms every time you have sex, limit your number of partners, and ask about a potential partner's sexual history.
  • Talk to your doctor about contraception. Many forms of contraception do not protect against the development of PID. Using barrier methods, such as a condom, might help to reduce your risk. Even if you take birth control pills, it's still important to use a condom every time you have sex to protect against STIs.
  • Get tested. If you're at risk of an STI, such as chlamydia, make an appointment with your doctor for testing. Set up a regular screening schedule with your doctor if needed. Early treatment of an STI gives you the best chance of avoiding PID.
  • Request that your partner be tested. If you have pelvic inflammatory disease or an STI, advise your partner to be tested and, if necessary, treated. This can prevent the spread of STIs and possible recurrence of PID.
  • Don't douche. Douching upsets the balance of bacteria in your vagina.

Last updated: May 17th, 2016

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