Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (acute PID) is a serious infection of the female reproductive organs. Anyone with a uterus, fallopian tubes, and ovaries can be affected, including menopausal women and transgender men.

PID can lead to serious complications

Acute pelvic inflammatory disease can cause scar tissue that grows between internal reproductive organs and causes symptoms of ongoing pelvic pain.

It can also lead to ectopic pregnancy, when the fertilized egg grows outside the uterus. An ectopic pregnancy can be life threatening, and makes it impossible for the fetus to survive.

Don't let pelvic inflammatory disease go untreated

Without treatment, PID can lead to chronic infection. About 1 out of 8 people diagnosed with PID will experience difficulty conceiving or have infertility.

Causes of pelvic inflammatory disease

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Pelvic inflammatory disease is a complication caused by bacteria that come from a sexually transmitted disease (STD) such as gonorrhea, or from a chlamydial infection. PID usually starts when sexually transmitted bacteria spreads from the vagina into the uterus, fallopian tubes or ovaries.

Certain bacterial infections that are not sexually transmitted can also cause PID. For example, bacteria can enter the reproductive tract any time the cervical barrier is disturbed, such as during menstruation or IUD insertion and after childbirth, miscarriage, or abortion.

When there is a build up of excessive bacteria, bacterial vaginosis (a type of vaginitis) can occur. Bacterial vaginosis is an inflammation of the vagina that can turn into an infection, that can then cause PID. Those of reproductive age are most likely to get bacterial vaginosis.

Symptoms of pelvic inflammatory disease

Symptoms of PID can be subtle or mild; some people may not have any symptoms until they realize they cannot conceive or have chronic pelvic pain. The most common PID symptoms include:

  • Abnormal and increased vaginal discharge.
  • Abnormal uterine bleeding in-between menstrual cycles.
  • Chronic pelvic pain.
  • Fever and chills.
  • Foul-smelling vaginal discharge.
  • Lower abdominal pain and tenderness (in the lower belly).
  • Pain during sex, sometimes accompanied by bleeding or spotting.
  • Severe pain and burning sensations during urination.
  • Upper abdominal pain on the right side.
  • Vomiting and nausea.

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The symptoms of PID may look like other health problems. Mild symptoms can often be mistaken as a sexually transmitted infection like chlamydia.

If you experience any of the symptoms, stop having sex and talk with your healthcare provider as soon as possible for a diagnosis.

Diagnosing pelvic inflammatory disease

There are no definitive tests for PID. A diagnosis generally is based on your overall health history, including sexual habits and history of past STIs, as well as a physical and a pelvic exam to test for tenderness and swelling. Other diagnostic procedures may include:

  • Blood tests. The doctor will draw blood to test for pregnancy, HIV, STIs, and white blood cell count for markers of infection or inflammation.
  • Culdocentesis. For this test, the healthcare provider puts a needle into the pelvic cavity through the vaginal wall to get a sample of peritoneal fluid from the posterior cul-de-sac, the space just behind the vagina.
  • Endometrial biopsy. The doctor inserts a thin tube into the uterus to take a sample of endometrial tissue to test for inflammation or infection.

  • Exam of vagina and cervix samples under a microscope, which can also be tested for signs of infection and certain bacterial organisms.
  • Laparoscopy. This is a minor procedure done using a thin tube with a lens and a light. It is put into a small incision in the belly to look at the reproductive and upper genital tract.
  • Pap test. For this test, cells are taken from the cervix and checked under a microscope. It’s used to find cancer, infection, or inflammation.
  • Ultrasound. This test uses high-frequency sound waves to make an image of the pelvic organs.

Treating pelvic inflammatory disease

With an early diagnosis, pelvic inflammatory disease can be cured.

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An antibiotic regimen

Your healthcare provider will typically recommend antibiotic treatment such as amoxicillin, during which your symptoms may be alleviated before the infection treatment course is completed. It is always recommended to finish the full course of antibiotics, even if symptoms subside, to make sure the disease does not come back.

It is also important to inform your sexual partner(s) about your diagnosis so they can also be tested for STDs or infections and receive treatment.

Note, though, that treatment for a pelvic infection will not undo any damage that has already happened to your reproductive organs. The later the treatment happens during the disease, the higher the likelihood you may have complications.

Risks of untreated PID

  • Chronic pelvic and abdominal pain. PID can cause pelvic pain lasting up to a few years due to the scarring of the fallopian tubes and pelvic organs.
  • Ectopic pregnancy (pregnancy outside of the womb). Without treatment, PID causes excessive scarring of the fallopian tubes. As a result, fertilized eggs are prevented from making their way to the uterus and instead implant within the fallopian tube. Ectopic pregnancies cause massive bleeding, and require emergency medical attention as they are a life threatening condition.
  • Infertility or difficulty trying to get pregnant. Damage to the reproductive organs by recurrent PID increases the risk factor for infertility.
  • Tubo-ovarian abscess. A collection of pus can form in the reproductive tract from PID, which can become a life-threatening infection if you do not undergo treatment.

If you get infected with another STD, you can also have recurrent PID (when the disease comes back).

Don’t ignore possible PID symptoms

Contact your doctor immediately for treatment if you experience the following severe symptoms (as they may indicate a complication and require hospitalization or intravenous antibiotics):

  • Excruciating pain in your lower abdomen.
  • Foul-smelling vaginal discharge.
  • Fever over 101 degrees F.
  • Nausea and vomiting, making you unable to keep anything down (including medications).

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Preventing pelvic inflammatory disease

The best way to prevent PID is to avoid contracting STDs like gonorrhea and chlamydia. Abstaining from vaginal, anal, and oral sex is a definitive prevention, but not realistic for sexually active individuals.

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For those who are sexually active, the following practices can reduce the risk of getting PID:

  • Being in a long-term, monogamous relationship (not having sexual partners outside of your current relationship).
  • Properly using condoms and safer sex supplies such as barriers and dental dams every time you have sex to prevent getting STDs.
  • If you have multiple sexual partners, make sure you and they get frequent STD testing, and disclose to one another if there are any positive results.
  • Not douching.