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.

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.

Signs and Symptoms

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.

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.

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.

 

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