Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It most often occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries. The signs and symptoms of pelvic inflammatory disease can be subtle or mild.
Some women don’t experience any signs or symptoms. As a result, you might not realize you have it until you have trouble getting pregnant or you develop chronic pelvic pain.

Symptoms

The signs and symptoms of pelvic inflammatory disease might be mild and difficult to recognize. Some women don’t have any signs or symptoms. When signs and symptoms of PID are present, they most often include:

• Pain — ranging from mild to severe — in your lower abdomen and pelvis
• Abnormal or heavy vaginal discharge that may have an unpleasant odor
• Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
• Pain during intercourse
• Fever, sometimes with chills
• Painful, frequent or difficult urination

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, itchy, burning in the vagina

If you have signs and symptoms of PID that aren’t severe, still see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can also be symptoms of 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.

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

There is a small increased risk of PID after the insertion of an intrauterine device (IUD). This risk is generally confined to the first three weeks after insertion.

The untreated pelvic inflammatory disease might cause scar tissue and pockets of infected fluid (abscesses) to develop in the reproductive tract. These can cause permanent damage to the reproductive organs. Complications from this damage might include:

• Ectopic pregnancy.PID is a major cause of tubal (ectopic) pregnancy. An ectopic pregnancy can occur when untreated PID has caused scar tissue to develop in the fallopian tubes. The scar tissue prevents the fertilized egg from making its way through the fallopian tube to implant in the uterus. Instead, the egg implants in the fallopian tube. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency medical attention.

• Damage to your reproductive organs may 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 reproductive tract. Most commonly, abscesses affect the fallopian tubes and ovaries, but they can also develop in the uterus or in other pelvic organs. If an abscess is left untreated, you could develop a life-threatening infection.

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, helps to reduce your risk. Even if you take birth control pills, use a condom every time you have sex with a new partner to protect against STIs.

• Get tested. If you’re at risk of an STI, 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 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.

Pelvic examination

There is no one test that can accurately diagnose pelvic inflammatory disease. Instead, your doctor will rely on a combination of findings from:

• Your medical history.Your doctor will likely ask about your sexual habits, history of sexually transmitted infections and method of birth control.

• Signs and symptoms.Tell your doctor about any symptoms you’re experiencing, even if they’re mild.

• A pelvic exam. During the exam, your doctor will check your pelvic region for tenderness and swelling. Your doctor may also use cotton swabs to take fluid samples from your vagina and cervix. The samples will be tested at a lab for signs of infection and organisms such as gonorrhea and chlamydia.

• Blood and urine tests. These tests may be used to test for pregnancy, HIV or other sexually transmitted infections, or to measure white blood cell counts or other markers of infection or inflammation.

• Ultrasound. This test uses sound waves to create images of your reproductive organs.

If the diagnosis is still unclear, your doctor may recommend additional tests, such as:

• LaparoscopyDuring this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

• Endometrial biopsyDuring this procedure, your doctor inserts a thin tube into the uterus to remove a small sample of endometrial tissue. The tissue is tested for signs of infection and inflammation.