Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of the reproductive organs in women. The pelvis is located in the lower abdomen and includes the fallopian tubes, the ovaries, the cervix, and the uterus. According to the U.S. Department of Health and Human Services, this condition is common and affects about one million women each year in the United States (HHS, 2010).

Several different types of bacteria can cause PID, including the same bacteria that cause the sexually transmitted infections (STIs) gonorrhea and chlamydia. What commonly occurs is that bacteria first enter the vagina and cause an infection. As time passes, this infection can move into the pelvic organs.

This condition can become extremely dangerous—even life threatening—if the infection spreads to your blood. If you suspect you may have an infection, see your doctor as soon as possible.

If you have gonorrhea or chlamydia, your risk of pelvic inflammatory disease increases. However, you can develop PID without ever having an STI. Other factors that can cause pelvic inflammatory disease include:

• having sex and being under the age of 25
• having sex with more than one person
• unprotected sex
• using an intrauterine device (IUD) to prevent a pregnancy
• douching
• a history of pelvic inflammatory disease

Some women with pelvic inflammatory disease do not have symptoms. For the women who do have symptoms, these can include:

• pain in the lower abdomen (the most common symptom)
• pain in the upper abdomen
• fever
• painful sex
• painful urination
• irregular bleeding
• lower back pain
• vaginal discharge
• tiredness

Pelvic inflammatory disease can cause mild or moderate pain. However, some women have severe pain and symptoms, such as:

• sharp pain in the abdomen
• vomiting
• fainting
• a high fever (greater than 101 F)

If you have severe symptoms, call your doctor immediately or go to the emergency room. The infection may have spread to your bloodstream or other parts of your body. Once again, this is a life-threatening condition.

Diagnosing PID

Your doctor may be able to detect PID after hearing your symptoms. But in most cases, your doctor will run tests to confirm the diagnosis. Tests include:

• pelvic exam: a test to check your pelvic organs
• cervical culture: a test to check your cervix for infections
• urine test: a test to check your urine for signs of blood, cancer, and other diseases

After collecting samples, your doctor sends these samples to a laboratory.

Assessing Damage

If your doctor determines that you have pelvic inflammatory disease, he or she may run more tests and check your pelvic area for damage. PID can cause scarring on your fallopian tubes and permanent damage to your reproductive organs. Additional tests include:

• pelvic ultrasound: imaging test that uses sound waves to create pictures of your internal organs
• endometrial biopsy: outpatient procedure where a doctor removes and examines a sample from the lining of your uterus
• laparoscopy: outpatient procedure where a doctor inserts a flexible instrument through an incision in your abdomen and takes pictures of your pelvic organs

Your doctor will likely have you take antibiotics to treat PID. Because your doctor may not know the type of bacteria that caused your infection, he or she may give you two different types of antibiotics to treat a variety of bacteria.

Within a few days of starting treatment, your symptoms may improve or go away. However, you should finish your medication. Stopping your medication early may cause the infection to return.

If you are sick, pregnant, cannot swallow pills, or have an abscess (pocket of pus caused by the infection) in your pelvis, your doctor may send you to the hospital for treatment.

Pelvic inflammatory disease may require surgery. This is rare and only necessary if an abscess in your pelvis ruptures (breaks) or your doctor suspects that an abscess will rupture.

The bacteria that cause PID can spread through sexual contact. If you are sexually active, your partner should also get treated for PID. Men may be silent carriers of bacteria that cause pelvic inflammatory disease. If your partner is not treated, your infection can recur.

You can lower your risk of PID by:

• practicing safe sex
• getting tested for sexually transmitted infections
• avoiding douches
• wiping from front to back to stop bacteria from entering your vagina

If you think that you have PID, make a doctor’s appointment. Other conditions, such as a urinary tract infection, can feel like pelvic inflammatory disease. However, your doctor can test for PID and rule out other conditions.

If you do not treat PID, your symptoms can worsen and lead to problems, such as:

• infertility: inability to conceive a child
• ectopic pregnancy: pregnancy that occurs outside the womb
• chronic pelvic pain: pain in the lower abdomen caused by scarring of the fallopian tubes and other pelvic organs

The infection can also spread to other parts of your body. If it spreads to your blood, it can even become life threatening.

Pelvic inflammatory disease is a very treatable condition and most women make a full recovery. However, about 10 to 15 percent of women with PID will have difficulty getting pregnant (CDC, 2011). Moreover, about nine percent of women will have an ectopic pregnancy, and 18 percent of women will have chronic pelvic pain as a result of PID (Berkeley County Health Department).