Pelvic Inflammatory Disease (PID)
What is pelvic inflammatory disease (PID)?
Reproductive organs affected by PID include the uterus, ovaries and fallopian tubes. When you have PID, you may feel stomach pain in your lower abdomen (belly). You may also have unusual discharge (leaking) from your vagina.
How do you get PID?
Most people typically get PID through unprotected sex, however 15% of these infections are not sexually transmitted. Sex may let bacteria enter the reproductive system, where they can infect the organs.
How does pelvic inflammatory disease affect me?
PID can damage parts of your reproductive system, including the uterus, ovaries and fallopian tubes. PID can be painful and make it difficult to become pregnant in the future. PID can also lead to a pocket of infection in the pelvis called a tubovarian abscess (TOA) which, if untreated can make people very sick.
Who’s at risk for PID?
You face a higher risk for pelvic inflammatory disease if you:
- Have a sexually transmitted infection (STIs), 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.
How common is pelvic inflammatory disease?
Each year, more than 1 million women in the U.S. get PID. And more than 100,000 women become infertile because of it, meaning they can’t have a baby. Many cases of ectopic pregnancies are also the result of PID. An ectopic pregnancy is when the baby starts to develop outside the uterus, most commonly in the fallopian tube. An untreated ectopic pregnancy needs immediate medical attention.
Cases of PID have dropped in recent years. The reason may be that more women get regular testing for chlamydia and gonorrhea, the main infections that lead to PID.
Symptoms and Causes
What causes pelvic inflammatory disease (PID)?
Bacteria entering the reproductive tract often cause pelvic inflammatory disease. These bacteria are passed from the vagina, through the cervix, into the uterus, fallopian tubes and ovaries, and into the pelvis.
Normally, when bacteria enter the vagina, the cervix keeps them from spreading deeper to other reproductive organs. But sometimes, the cervix becomes infected from an STI like gonorrhea and chlamydia. When that happens, it’s less able to keep bacteria out.
Untreated gonorrhea and chlamydia cause about 90% of PID cases. Other causes include:
- Pelvic procedures.
- Insertion of an intrauterine device (IUD), either copper or hormonal. The risk is highest in the few weeks after insertion. Many times this type of infection is preventable with STI testing around the time of IUD placement.
Does douching cause pelvic inflammatory disease (PID)?
Most studies report only a very weak association between douching and PID. What can be said is that douching can lead to bacterial vaginosis infections, but there is only a potential association between douching and PID.
What are the symptoms of PID?
You may not realize you have PID. Symptoms might be mild or unnoticeable. But symptoms of PID can also start suddenly and quickly. They can include:
- Pain or tenderness in the 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.
- Pain in the right upper abdomen, less often.
Diagnosis and Tests
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.
Usually, your healthcare provider can diagnose PID through:
- Medical history, including asking about your general health, sexual activity and symptoms.
- Pelvic exam to examine your reproductive organs and look for signs of infection.
- Vaginal culture to take a sample of any 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 the reproductive system.
In some cases, your provider may recommend:
- Endometrial biopsy to remove and test a small tissue sample from the endometrium, the lining of the uterus.
- Laparoscopy, a surgery using small incisions and a lighted instrument to look closely at reproductive organs.
- Culdocentesis, with a needle inserted behind the vagina to remove fluid for examination. This procedure is much more rare then it used to be, but is sometimes helpful.
Management and Treatment
How is pelvic inflammatory disease (PID) treated?
Your provider will prescribe antibiotics that you take by mouth. 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 medicine 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.
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(s) need treatment for pelvic inflammatory disease?
If you have pelvic inflammatory disease, tell your sexual partner(s). They should also get treated, for their sake and yours. Otherwise, you may get PID again when you resume sex.
Can I prevent pelvic inflammatory disease?
Sometimes, PID is not 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. Protect yourself from sexually transmitted infections (STIs) that can cause PID:
- Limit sexual partners: Your risk increases if you have multiple partners.
- Choose 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.
- Seek 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.
- Get regular checkups: Have regular gynecological exams and screenings. Often, providers can identify and treat cervical infections before they spread to reproductive organs.
Do I need regular sexually transmitted infection tests?
If you’re sexually active, talk to your healthcare provider about yearly testing for sexually transmitted infections. Providers often recommend testing for chlamydia to help keep you safe. It’s also helpful to get tested before having sex with a new partner.
Outlook / Prognosis
Can pelvic inflammatory disease be cured?
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 to stay healthy.
Are there complications of PID?
If you get PID several times, you can develop scarring on the fallopian tubes. The scarring can lead to several problems, including:
- Chronic pelvic pain.
- Ectopic pregnancy.
If I had pelvic inflammatory disease, will I have trouble getting pregnant?
PID can affect fertility. Of the women who had PID, studies found that 1 in 8 had difficulty getting pregnant. People who had repeat infections had a harder time getting pregnant.
How does PID affect fertility?
An egg needs to travel from your ovary, down the fallopian tube and into the uterus (womb). Then the sperm can fertilize it. But bacteria from PID can cause scarring on your fallopian tubes. The scar tissue makes it harder for the egg to get where it needs to go.
Can I get pelvic inflammatory disease again?
Yes, you can get re-infected. 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.
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. And if you had unprotected sex, it’s a good idea to talk to your provider, even if you don’t feel symptoms. The sooner you get treated, the more likely it will be effective. Prompt treatment also reduces your risk of serious complications.
Other tips for taking care of yourself:
- 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 about PID?
See your provider if you experience any symptoms of PID. Seek immediate medical care if you have:
- Intense lower belly pain.
- Severe vomiting.
- High fever (higher than 101 F).
What should I ask my healthcare 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 possible complications of PID?
- When can I resume having sex?
- What can I do to prevent PID?
A note from Cleveland Clinic
Pelvic inflammatory disease (PID) is an infection of your reproductive organs. It’s usually caused by a sexually transmitted infection, such as gonorrhea or chlamydia. Avoid douching. Although the evidence is weak, douching may be tied to PID; it can definitely lead to bacterial vaginosis. 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 essential 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.
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