Pelvic Inflammatory Disease (PID)
What is pelvic inflammatory disease (PID)?
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID usually is contracted through sexual contact. PID can damage the uterus, ovaries, Fallopian tubes, or other parts of the female reproductive system. It also can cause severe pain and make it difficult to become pregnant.
How common is pelvic inflammatory disease (PID)?
Each year, more than 1 million women in the United States have an episode of PID. As a result of PID, more than 100,000 women become infertile (unable to have a baby) each year. In addition, a large proportion of the ectopic (tubal) pregnancies that occur each year can be linked to PID. The rate of infection is highest among teenagers.
What are the risk factors for pelvic inflammatory disease (PID)?
- Women with sexually transmitted diseases—especially gonorrhea and chlamydia—are at greater risk for developing PID.
- Women with many sexual partners are at greater risk for sexually transmitted diseases and PID.
- Women who have already had PID are at higher risk for another episode.
- Sexually active teenagers are more likely to develop PID than are older women.
Some studies suggest that douching may contribute to PID. Douching may push bacteria into the upper genital tract and may mask the discharge that could cause a woman to seek medical attention.
What are the complications of pelvic inflammatory disease (PID)?
Repeated episodes of PID can result in scarring of the Fallopian tubes, which can lead to infertility, ectopic (tubal) pregnancy, or chronic (long-term) pelvic pain. Among women who have had PID, 1 in 8 have difficulties getting pregnant.
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Symptoms and Causes
What causes pelvic inflammatory disease (PID)?
Normally, the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to a sexually transmitted disease—such as gonorrhea and chlamydia—the cervix itself becomes infected and is less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract. Untreated gonorrhea and chlamydia cause about 90% of all cases of PID. Other causes include abortion, childbirth, and pelvic procedures.
What are the symptoms of pelvic inflammatory disease (PID)?
The symptoms of PID can vary, but may include the following:
- Dull pain or tenderness in the stomach or lower abdominal area, or pain in the right upper abdomen (though this is much less common)
- Abnormal vaginal discharge that is yellow or green in color and has an unusual odor
- Irregular periods
- Spotting or cramping throughout the month
- Chills or high fever
- Nausea and vomiting
- Pain during sex
Diagnosis and Tests
How is pelvic inflammatory disease (PID) diagnosed?
For most women, only a medical history, pelvic exam, and vaginal cultures are needed to make the diagnosis of PID.
Your doctor will begin with a detailed history of your general health and sexual activity. He or she will perform a pelvic exam to check the health of your reproductive organs, and look for evidence of gonorrhea and chlamydia infection. In addition, your provider may also order blood tests to look for signs of infection, and ultrasound (sonogram), the use of sound waves to form an image of the reproductive organs.
Though not commonly needed, other tests are available to take care of you, if needed, including:
- Endometrial biopsy, a procedure in which a small sample of tissue from the lining of the uterus (endometrium) is removed for evaluation and testing;
- Laparoscopy, a procedure during which a thin, lighted instrument (laparoscope) is inserted through a small cut in the lower abdomen to allow the doctor to examine the internal reproductive organs;
- Culdocentesis, a procedure in which a needle is inserted behind the vagina. Fluid is removed through the needle and examined for signs of bleeding or infection.
Management and Treatment
How is pelvic inflammatory disease treated?
If the findings of your exam and tests suggest PID, your doctor will begin treatment immediately. The initial treatment for PID usually consists of one or more antibiotic medications taken by mouth (orally). If treatment is not effective, if you cannot take antibiotics by mouth, or if the infection is severe, you may need to be hospitalized to receive medication intravenously (directly into a vein).
If you are diagnosed with PID, your sexual partner(s) also must be treated. Otherwise, PID will likely come back when you have sex again.
How can pelvic inflammatory disease be prevented?
The following measures can help you avoid PID:
- Avoid multiple sexual partners.
- Use barrier methods of birth control (condoms and/or a diaphragm) and spermicides, even if you use birth control pills.
- Seek treatment immediately if you notice signs of PID or any sexually transmitted disease, including unusual vaginal discharge, pelvic pain, or bleeding between periods.
- Have regular gynecologic check-ups and screenings. Many cervical infections can be identified and treated before they spread to the internal reproductive organs.
Centers for Disease Control and Prevention. Pelvic Inflammatory Disease (PID)-CDC Fact Sheet Accessed 9/29/2015.
Office on Women’s Health, U.S. Department of Health and Human Services. Pelvic inflammatory disease fact sheet Accessed 9/29/2015.
American Congress of Obstetricians and Gynecologists. Pelvic Inflammatory Disease (PID) Accessed 9/29/2015.
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