Pelvic Inflammatory Disease

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease (PID) is a serious infection in your uterus, fallopian tubes and/or ovaries. It affects women and people assigned female at birth (AFAB). PID develops when certain types of bacteria spread from your vagina to your reproductive organs. Bacteria from untreated sexually transmitted infections (STIs) are the most common cause of PID. However, bacteria normally found in your vagina can also cause PID.

When you have PID, you may feel pain in your lower abdomen (belly) or pelvis. You may also have unusual discharge (leaking) from your vagina. Severe PID can cause permanent damage your reproductive organs and prevent you from getting pregnant. Getting tested and treated for STIs is the best way to prevent PID.

How do you get PID?

Most people get PID through unprotected sex. Sex lets bacteria enter your reproductive system, where they can infect your organs.

How common is pelvic inflammatory disease?

Each year, more than 1 million women and people AFAB in the U.S. get PID. And more than 100,000 people become infertile because of it. PID occurs most frequently in women and people AFAB between 15 and 25 years old.

What are the most common signs of PID?

You may not realize you have PID. Symptoms might be mild or unnoticeable. But symptoms of PID can also start suddenly. They can include:

• Pain or tenderness in your stomach or lower abdomen (belly), the most common symptom.
• Abnormal vaginal discharge, usually yellow or green with an unusual odor.
• Chills or fever.
• Nausea and vomiting.
• Pain during sex.
• Burning when you pee.
• Irregular periods or having spotting or cramping throughout the month.

Where do you feel PID pain?

Pelvic inflammatory disease pain is mainly felt in your lower abdomen or pelvic region. It may feel tender and sore or like a dull ache. You may also feel pain deep in your pelvis during sex.

What causes pelvic inflammatory disease (PID)?

Bacteria entering your reproductive tract causes pelvic inflammatory disease. These bacteria are passed from your vagina, through your cervix and up into your uterus, fallopian tubes and ovaries. Normally, when bacteria enter your vagina, your cervix keeps them from spreading deeper to other reproductive organs. However, any type of infection can disrupt your cervix, preventing it from doing its job.

Many types of bacteria can cause PID, but the two most common infections that cause PID are gonorrhea and chlamydia. You get both of these infections through unprotected sex. These two STIs cause about 90% of all PID cases.

Less commonly, PID happens when normal bacteria gets into your reproductive organs. This can happen after:

• Childbirth.
• Pelvic surgery.
• Miscarriage.
• Getting an intrauterine device (IUD). The risk is highest in the few weeks after your provider inserts an IUD.

How long does it take to have symptoms of PID?

It can take anywhere from a few days to a few weeks to develop PID if untreated gonorrhea or chlamydia is the cause. If you get PID from something else, it may take several months to develop it.

Does douching cause pelvic inflammatory disease (PID)?

Most studies report only an association between douching and PID. What can be said is that douching can lead to bacterial vaginosis infections, but there’s only a potential association between douching and PID. Most healthcare providers advise against douching.

Is PID contagious?

Yes, PID spreads most often during direct sexual contact.

Who’s at risk for PID?

You’re at higher risk for pelvic inflammatory disease if you:

• Have a sexually transmitted infection (STI), especially gonorrhea or chlamydia.
• Have many sexual partners or have a partner who has had multiple partners.
• Have had PID in the past.
• Are sexually active and younger than 25.
• Have had tubal ligation or other pelvic surgery.

Are there complications of PID?

The longer you have PID, the more serious its effects can become. The infection can cause scar tissue to form inside your fallopian tubes. The scarring can lead to several problems, including:

• Chronic pelvic pain: Long-lasting pelvic pain is the most common complication. One study estimates about 20% of people develop chronic pelvic pain.
• Ectopic pregnancy: Scarring can prevent a fertilized egg from moving into your uterus. This can cause it to implant inside your fallopian tubes instead. The rate of ectopic pregnancy in people with PID is much higher than in people without PID.
• Infertility: Up to 10% of people with PID lose the ability to get pregnant because scar tissue blocks their fallopian tubes and prevents them from releasing an egg.
• Tubo-ovarian abscess (TOA): TOA is a pocket of infection in your pelvis that can make you extremely sick.

How is pelvic inflammatory disease diagnosed?

If you feel symptoms of PID, see your healthcare provider right away. The sooner you get care, the greater your chances of successful treatment. There isn’t one specific test for PID. Usually, your healthcare provider can diagnose PID through:

• Asking about your medical history, including your general health, sexual activity and symptoms.
• A pelvic exam to examine your reproductive organs and feel for tenderness or abscesses (collections of pus).
• A vaginal culture to test your vaginal discharge for certain bacteria.

What other tests might I need to diagnose PID?

Your provider may also order:

• Blood tests.
• Urine test to rule out a urinary tract infection, which causes similar pelvic pain.
• Ultrasound to get clearer images of your reproductive system.
• Testing for STIs.

In some cases, your provider may recommend:

• Endometrial biopsy: Your provider removes a small tissue sample from your uterine lining and tests it for diseases.
• Laparoscopy: Your provider makes small incisions in your pelvis, then inserts a lighted instrument to look more closely at your reproductive organs.

How is pelvic inflammatory disease (PID) treated?

Your provider will prescribe antibiotics that you take by mouth, typically for 14 days. Make sure to take all your medicine, even if you start feeling better. Often, your symptoms improve before the infection goes away. Your provider may recommend you return a few days after starting the medicine. They can check that treatment is working.

Some people take antibiotics and still have symptoms. If that happens, you may need to go to the hospital to receive antibiotics through an IV. You may also need IV medication if you:

• Are pregnant.
• Have a severe infection and feel very sick.
• Have an abscess (collection of pus) in your fallopian tube or ovary.

You shouldn’t have sex until you finish treatment. When you do have sex again, use condoms every time to prevent infections.

Will I need surgery for pelvic inflammatory disease?

Surgery is rare for PID but can help in some cases. If you still have symptoms or an abscess after taking antibiotics, talk to your healthcare provider about surgery.

Does my partner need treatment for pelvic inflammatory disease?

If you have pelvic inflammatory disease, tell your sexual partner(s). They should receive treatment. Otherwise, you may get PID again when you resume sex.

Can I prevent pelvic inflammatory disease?

Sometimes, PID isn’t due to a sexually transmitted infection. It can come from normal vaginal bacteria traveling to your reproductive organs. Avoiding douching may lower the risk.

Most of the time, though, PID happens because of unprotected sex. Take steps to practice safe sex. Ways to protect yourself from sexually transmitted infections (STIs) that can cause PID include:

• Limiting sexual partners: Your risk increases if you have multiple partners.
• Choosing barrier methods of birth control: These types of birth control include condoms and diaphragms. Combine a barrier method with spermicide, even if you take birth control pills.
• Seeking treatment if you notice symptoms: If you notice signs of PID or other STIs, get treatment right away. Symptoms include unusual vaginal discharge, pelvic pain or bleeding between periods.
• Getting regular checkups: Have regular gynecological exams and screenings. Often, providers can identify and treat cervical infections before they spread to reproductive organs.

How can I lower my risk for PID?

If you’re sexually active, talk to your healthcare provider about yearly testing for sexually transmitted infections. Providers often recommend testing for chlamydia and gonorrhea to help keep you safe. Also, before having sex with a new partner, it’s a good idea for both of you to get tested for STIs.

Is there a cure for pelvic inflammatory disease?

If you get prompt diagnosis and treatment for an infection, antibiotics can cure PID. But treatment can’t reverse any damage that already happened to your reproductive organs. Don’t wait to get treated. See your provider right away so you can get the help you need.

If I had pelvic inflammatory disease, will I have trouble getting pregnant?

PID can affect fertility. Of the people who had PID, studies found that 1 in 8 had difficulty getting pregnant. Up to 1 in 10 people ultimately received a diagnosis of infertility. People who had repeat infections had a harder time getting pregnant.

How does PID affect fertility?

Bacteria from PID can cause scarring on your fallopian tubes. This scar tissue makes it harder for an egg to get from your ovary to your fallopian tube, then down to your uterus. If an egg can’t get through your fallopian tube, sperm can’t fertilize it.

Can I get pelvic inflammatory disease again?

Yes, you can get PID again. Getting PID once doesn’t protect you from getting it again.

If I had PID, when can I resume having sex?

You and your partner should wait a week after finishing your antibiotics before resuming sex. Doing so will help prevent re-infection.

Can women who have sex with women get PID?

Yes, it’s possible to get PID if you’re a woman or person AFAB and only have sex with other women or people AFAB. This is because bacteria that cause PID can live on a vagina, penis or any object you place in your vagina.

How can I take care of myself if I have pelvic inflammatory disease?

If you feel symptoms of PID, see your healthcare provider right away. If you have PID, the most important thing you can do is get treatment.

Other tips for taking care of yourself include:

• Avoid douching to prevent pushing bacteria upward from your vagina into your uterus and fallopian tubes.
• Return to your healthcare provider a few days after starting medication to make sure it’s working.
• Take all your medicine as directed.
• Use condoms or dental dams every time you have sex to protect yourself from infections.
• Wait one week after you (and your partner) have finished medication to resume your sex life.

When should I see my healthcare provider?

See your provider if you experience any symptoms of PID. Seek immediate medical care if you have:

• Intense lower belly pain.
• Smelly or discolored vaginal discharge.
• Severe vomiting.
• High fever.

What questions should I ask my provider?

If you have PID, ask your provider:

• What treatment will I need?
• Do I need to get rechecked?
• Will PID affect my ability to get pregnant?
• What are the possible complications of PID?
• When can I resume having sex?
• What can I do to prevent PID?

Can you get PID without having an STD?

Yes, it’s possible to get PID when the bacteria that normally exist in your vagina travel up into your reproductive organs. This is usually not the cause, though.

Is pelvic inflammatory disease serious?

Yes, PID can be serious. Early diagnosis and treatment are essential to reducing your risk of long-term complications like infertility.

A note from Cleveland Clinic

Pelvic inflammatory disease (PID) is an infection of your reproductive organs. A sexually transmitted infection, such as gonorrhea or chlamydia, typically causes it. If you notice symptoms of PID, such as pain in your lower abdomen, talk to your healthcare provider. The provider can diagnose PID and give you antibiotics to treat it. Early treatment is key to avoiding complications of PID such as infertility. Your partner(s) should get treated, as well. You can prevent PID by using a condom every time you have sex.