Pelvic Inflammatory Disease (PID)

PID at a glance

• Pelvic inflammatory disease, or PID, is an infection in the ovaries, fallopian tubes and uterus.
• Most commonly PID is caused by untreated sexually transmitted diseases (STD), specifically gonorrhea and chlamydia.
• Symptoms can include lower abdomen pain, fever, irregular bleeding, pain during urination and more.
• PID increases the risks of ectopic pregnancy and infertility.
• Sometimes infections can occur without pain, and technically these are not PID, however, they can lead to infertility.
• Anyone who has a history of chlamydia or gonorrhea is at increased risk for PID and infertility.

What is pelvic inflammatory disease?

Pelvic inflammatory disease is an infection of the female reproductive organs that can cause chronic pain and infertility. PID is a common illness, with more than 1 million women diagnosed in the United States every year. According to the Centers for Disease Control (CDC), 1 in 8 women with PID will experience difficulties getting pregnant.

PID is caused by bacteria spreading from the vagina to the uterus, ovaries or fallopian tubes. The most common causes are sexually transmitted diseases (STD), specifically gonorrhea and chlamydia. A less common cause of PID is when bacteria enter the reproductive tract after the cervix is disturbed such as after childbirth or miscarriage.

 Related Reading: Fertility Testing in Women

What are the risk factors for pelvic inflammatory disease?

There are a number of factors that increase the risk of PID. Some of these factors include:

• A history of STD.
• Multiple sexual partners.
• Sex without a condom.
• Douching.
• A single sex partner who has multiple partners.
• A history of PID.

Using an intrauterine device (IUD) can create a risk for pelvic inflammatory disease, but it is limited to the first three weeks after it is placed in the uterus.

Can PID be prevented?

While there is no way to completely prevent pelvic inflammatory disease, there are a few simple ways to reduce the chances of getting it through an STD.

An important step in prevention is getting tested. Both partners should get tested for STDs and if either of you has a new partner, get retested. Identifying if there is a problem can direct the course of action for dealing with the STD and preventing pelvic inflammatory disease.

People can reduce the risk of PID by practicing safe sex including using condoms every time and limiting the number of sexual partners. Condoms are the most effective way to prevent contracting an STD. Having multiple sexual partners increases the risks of exposure to sexually transmitted diseases.

Finally, women should not douche. Douching can remove some the normal bacteria in the vagina that protect against infection. By removing the bacteria, it creates an opportunity for harmful bacteria to travel to the ovaries, uterus and fallopian tubes.

What are pelvic inflammatory disease symptoms?

Sometimes pelvic infections produce no or only mild symptoms, but they can also be severe. A pelvic infection that has no symptoms can cause damage to the reproductive tract in women, but only women with severe symptoms are given a diagnosis of PID.

To make the diagnosis of pelvic inflammatory disease, a healthcare provider needs to document the three signs or symptoms:

• Pain or tenderness in the lower abdomen.
• Tenderness on physical examination when the woman’s cervix is moved (called cervical motion tenderness).
• Tenderness in the area of the tubes and or ovaries to the side(s) of the uterus.

Other findings associated with PID may include:

• Pain during sex.

• Abnormal uterine bleeding such as between menstrual cycles or during sex.
• Painful urination.
• Foul smelling discharge from the vagina.
• Fever and chills.

It is important to note that not all pelvic pain is PID. Pelvic pain can be caused by endometriosis, musculoskeletal problems, irritable bowel syndrome, fibroids and more. Because a number of issues can cause pelvic pain, it is important for a woman to speak with a doctor if she experiences any of these symptoms.

Treatments & complications of untreated PID

Pelvic inflammatory disease can be treated and cured, if it is diagnosed early. We treat PID with antibiotics. While the symptoms may dissipate shortly after starting the antibiotics, it is imperative to take all the medication prescribed.

Treatment of PID does not reverse any damage done to the reproductive system. There is also an increased chance of complications from pelvic inflammatory disease the longer it goes untreated. Some of those complications follow.

• PID can damage the reproductive organs so much that it can result in infertility. The risk of infertility increases each time pelvic inflammatory disease occurs and the longer it goes untreated.
• If left untreated, pelvic inflammatory disease can cause the formation of scar tissue, outside and inside the fallopian tubes. This can result in tubal blockage or fallopian tube obstruction. This block means that the sperm and egg cannot converge, meaning fertilization is not possible. The blockage can also prevent a fertilized egg (embryo) from traveling through fallopian the tube to implant in the uterus for pregnancy. Tubal factor infertility accounts for about 25 to 30 percent of female infertility.
• A tubo-ovarian abscess can develop from pelvic inflammatory disease. An abscess, which is a collection of pus, can form on the uterus, fallopian tubes and ovaries. If this is not treated, it can result in a life-threatening infection.
• Ectopic pregnancy is another life-threatening complication of this disease. Pelvic inflammatory disease is one of the major causes of ectopic, or tubal, pregnancies. The scar tissue formed can prevent a fertilized egg from moving through the fallopian tube to implant in the uterus, causing the embryo to implant outside the uterus and continue to develop. Ectopic pregnancies can cause severe bleeding.
• Pelvic inflammatory disease can result in chronic pelvic pain if it is not addressed. This pain can last for months or sometimes, years. This pain can be exacerbated during intercourse or ovulation.