Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID is usually due to sexually transmitted infections (STDs), which spread from your vagina to your uterus, fallopian tubes, and ovaries. Many women with pelvic inflammatory disease develop or experience virtually no signs or symptoms and thus remain untreated. PID is often only discovered when you have trouble getting pregnant or when you experience chronic pelvic pain. Roughly 1 in 8 women who have had PID experience difficulty getting pregnant. Treatment of pelvic inflammatory disease consists of antibiotics. Sometimes surgical intervention is necessary.
- What is pelvic inflammatory disease (PID)?
- How common is PID?
- Pelvic inflammatory disease causes
- Pelvic inflammatory disease symptoms
- Risk factors PID
- Diagnosis and research
- History and physical examination
- Additional research
- Pelvic inflammatory disease treatment
- Treat your partner
Pelvic Inflammatory Disease / Source: Alila Medical Media/Shutterstock
What is pelvic inflammatory disease (PID)?
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID is one of the most serious complications of a sexually transmitted disease, especially chlamydia, in women. It can lead to irreversible damage to the uterus, ovaries, fallopian tubes, or other parts of the female reproductive system, and is the leading cause of infertility in women.
Other names for pelvic inflammatory disease are salpingitis, adnexitis or pelvic inflammatory disease. It is also known as pelvic inflammatory disease.
How common is PID?
The incidence is 0.7 per 1,000 women per year. In the age group 25-45 years this is even 0.7-1.7 per 1,000 women. These are probably underestimates, as PID often has no symptoms and is therefore not detected.
Pelvic inflammatory disease causes
Normally, the cervix will prevent bacteria that enter the vagina from spreading to the internal genitalia. If the cervix is exposed to a sexually transmitted infection (STI), such as gonorrhea or chlamydia, it itself becomes infected and is therefore less able to prevent the spread of disease-causing 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 approximately 90% of all cases of PID. Other causes include abortion, childbirth, and treatments involving the pelvis.
Nausea with PID / Source: Istock.com/CentralITAlliance
Pelvic inflammatory disease symptoms
The symptoms of PID vary but may include:
- Tenderness or dull pain in the lower abdomen, or pain in the upper right abdomen (ovarian or uterine pain);
- Abnormal vaginal discharge, yellow or green in color or with an unusual odor;
- Pain when urinating;
- Chills or high fever;
- Nausea and vomiting;
- Pain during sexual intercourse.
Risk factors PID
There are a number of risk factors that increase the risk of pelvic inflammatory disease. Women with a sexually transmitted disease, especially chlamydia but also gonorrhea, are at greater risk of developing PID. Women who have had PID before have a higher risk of getting it again. Sexually active teens are more likely to develop PID than older women. Women with frequent sexual partners are at greater risk for sexually transmitted infections (STDs) and PID. Some studies suggest that vaginal douching may contribute to PID. It disrupts normal vaginal fauna and can potentially push bacteria further into the vagina. It can also mask discharge, while discharge is a signal that something is wrong.
Normal and ectopic pregnancy / Source: BruceBlaus, Wikimedia Commons (CC BY-SA-4.0)
Untreated pelvic inflammatory disease can cause scar tissue and abscesses to form in your fallopian tubes and can also cause damage to your reproductive organs. Complications of PID can include:
- Ectopic Pregnancy;
- Infertility; and
- Chronic pelvic pain (pelvic pain).
Diagnosis and research
History and physical examination
The doctor starts by assessing your general health and sexual activity. He will ask questions about your complaints and also take your medical history into account. This is followed by a physical examination. The doctor will often first examine the abdomen, followed by an internal examination. We will also check whether you have a fever. Cultures can be taken during the internal examination (see below). The doctor will also use two fingers of one hand and the other to probe the abdomen, uterus and ovaries.
Speculum or duckbill / Source: Saltanat, Wikimedia Commons (Public domain)
When examined with a speculum, popularly called a ‘duckbill’, the doctor can take cultures, which are examined in the laboratory for the presence of pathogens (chlamydia, gonorrhea or other bacteria).
Additional research may include:
- Blood tests, looking for indications of inflammation (increased number of white blood cells or increased erythrocyte sedimentation rate);
- Ultrasound examination to exclude other causes of abdominal pain;
- Pregnancy test to investigate whether there is an ectopic pregnancy.
- Endometrial biopsy, a procedure in which a small sample of tissue is removed from the lining of the uterus for microscopic examination;
- Laparoscopy, a procedure in which a thin instrument (laparoscope) is inserted through a small incision in the lower abdomen to examine the internal genitalia.
Pelvic inflammatory disease treatment
As soon as the diagnosis of pelvic inflammatory disease is made, treatment will begin immediately.
Antibiotics to treat PID / Source: Stevepb, Pixabay
Initial treatment for mild cases of PID usually consists of one or more antibiotic medicines taken by mouth. More severe cases can be treated with a combination of intravenous and oral antibiotics if necessary. If treatment does not work or if the infection is severe, you may need to be admitted to hospital. Here you will receive the medication intravenously (directly into a vein). After being on a drip for a few days, treatment is often continued with tablets.
Treat your partner
If you have been diagnosed with PID and the culprit is a sexually transmitted disease, it is important that your sexual partner is examined and, if necessary, treated. This prevents reinfection. Use a condom until your partner has received adequate treatment.
When PID causes an abscess, surgery is often required to remove it. Depending on the circumstances, this may be done with a laparoscope or a procedure in which the doctor opens the abdomen to view the internal organs (laparotomy). Both techniques are performed under general anesthesia. If abscesses have formed on the uterus or ovaries, your doctor may recommend hysterectomy (removal of the uterus) or oophorectomy or oophorectomy (removal of the ovaries).
Location in pelvic inflammatory disease / Source: BruceBlaus, Wikimedia Commons (CC BY-3.0)
Normally the complaints disappear quickly with adequate treatment and you will feel a lot better within a few days. Therapy adherence is the key word here. Complete the prescribed treatment, even if you feel well again.
Pelvic inflammatory disease is preventable. The number one cause of PID is an untreated STD. Steps you can take to prevent PID include:
- Sexual abstinence is the best method to prevent an STD;
- Only engage in sexual activity within a long-term, mutually monogamous relationship with a person who is not known to have an STD;
- Avoid changing sexual partners;
- Use a condom if you want to have sex outside of a long-term, mutually monogamous relationship.
Go to your doctor immediately if you experience symptoms that may indicate PID or a sexually transmitted disease, including unusual vaginal discharge, pelvic pain, or intermittent bleeding.
- Green discharge: causes of green vaginal discharge
- Fallopian tube inflammation: lower abdominal pain and discharge
- Fallopian tube inflammation: symptoms, cause and treatment
- Brown discharge: causes of brown vaginal discharge
- Vaginal discharge: odor and color (yellow, brown or green)