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.

Many women who develop pelvic inflammatory disease either experience no signs or symptoms or don't seek treatment. Pelvic inflammatory disease may be detected only later when you have trouble getting pregnant or if you develop chronic pelvic pain.

Signs and symptoms of pelvic inflammatory disease may include:

  • Pain in your lower abdomen and pelvis
  • Heavy vaginal discharge with an unpleasant odor
  • Irregular menstrual bleeding
  • Pain during intercourse
  • Fever
  • Painful or difficult urination

PID may cause only minor signs and symptoms or none at all. PID with mild or no symptoms is especially common when the infection is due to chlamydia.

When to see a doctor

Go to the emergency room if you experience the following severe signs and symptoms of PID:

  • Severe pain low in your abdomen
  • Vomiting
  • Signs of shock, such as fainting
  • Fever, with a temperature higher than 101 F (38.3 C)

If your signs and symptoms aren't severe, but they're persistent, 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 appear, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

Pelvic inflammatory disease can be caused by a number of bacteria but are most often caused by gonorrhea or chlamydia infections. These bacteria are usually acquired during unprotected sex.

Less commonly, bacteria may enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen after intrauterine device (IUD) insertion, childbirth, miscarriage or abortion.

A number of factors may 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
  • Having had an IUD inserted recently
  • Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment
  • Having a history of pelvic inflammatory disease or a sexually transmitted infection

Untreated pelvic inflammatory disease may cause scar tissue and collections of infected fluid (abscesses) to develop in your fallopian tubes and damage your reproductive organs. Complications may include:

  • Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. In an ectopic pregnancy, the fertilized egg can't make its way through the fallopian tube to implant in the uterus. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency surgery.
  • Infertility. PID may 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 may last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.

If you have signs or symptoms of pelvic inflammatory disease, make an appointment to see your doctor or other health care provider.

Here's some information on what you can do to get ready and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Write down questions to ask your doctor.

Some basic questions to ask include:

  • What kinds of tests do I need?
  • Is this a sexually transmitted infection?
  • Should my partner be tested or treated?
  • Do I need to stop having sex during treatment? How long should I wait?
  • How can I prevent future episodes of pelvic inflammatory disease?
  • Will this affect my ability to become pregnant?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Can I be treated at home? Or will I need to go to a hospital?
  • Do you have any printed materials that I can take with me? What websites do you recommend?
  • Do I need to come back for a follow-up visit?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • Do you have a new sexual partner or multiple partners?
  • Do you always use condoms?
  • When did you first begin experiencing symptoms?
  • What are your symptoms?
  • Are you experiencing any pelvic pain?
  • How severe are your symptoms?

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 uses a cotton swab to take samples from your vagina and cervix. The samples are sent to a lab for analysis to determine the organism that's causing the infection.

To confirm the diagnosis or to determine how widespread the infection is, your doctor may recommend other tests, such as:

  • Ultrasound. This test uses sound waves to create images of your reproductive organs.
  • Endometrial biopsy. During this procedure, your doctor removes a small piece of your uterine lining (endometrium) for testing.
  • Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Treatment for pelvic inflammatory disease may include:

  • Antibiotics. Your doctor may prescribe a combination of antibiotics to start taking right away. After receiving your lab test results, your doctor may adjust the medications you're taking to better match what's causing the infection.

    Usually, your doctor will request a follow-up visit in 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 that's already been done.

  • Treatment for your partner. To prevent reinfection with an STI, advise your sexual partner or partners to be examined and treated. Partners can be infected and 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.

More-serious cases

Outpatient treatment is adequate for treating most women with pelvic inflammatory disease. However, if you're seriously ill, pregnant or haven't responded to oral medications, you may need hospitalization. At the hospital, you may receive intravenous (IV) antibiotics, followed by antibiotics you take by mouth.

Surgery is rarely necessary. However, if an abscess ruptures or threatens to rupture, your doctor may drain it.

In addition, surgery may be performed on women who don't respond to antibiotic treatment or who have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.

Often a diagnosis of pelvic inflammatory disease happens when you have a sexually transmitted infection. Finding out that you have an STI can be traumatic. Put your initial shock on hold so that you can take the steps immediately necessary to get treated and to prevent reinfection.

If you've experienced more than one episode of pelvic inflammatory disease, you're at greater risk of infertility. If you've been trying to become pregnant without success, make an appointment with your doctor for an infertility evaluation. Your doctor or a reproductive health specialist may perform tests to determine whether or not your history of pelvic inflammatory disease is causing the problem and, if so, outline your options.

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. Some forms of contraception may affect your risk of developing pelvic inflammatory disease. A contraceptive intrauterine device (IUD) may increase your risk of PID temporarily for the first few weeks after insertion, but a barrier method, such as a condom, reduces your risk.

    Use of a birth control pill alone offers no protection against acquiring STIs. But the pill may offer some protection against the development of PID by causing your body to create thicker cervical mucus, making it more difficult for bacteria to reach your uterus, fallopian tubes or ovaries. It's still important to use a condom every time you have sex, however.

  • 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 you need to. Early treatment of an STI gives you the best chance of avoiding pelvic inflammatory disease.
  • 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.
  • Pay attention to hygiene habits. Wipe from front to back after urinating or having a bowel movement to avoid introducing bacteria from your colon into the vagina.
May 01, 2014