An Overview of Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an inflammatory infection that affects the uterus, ovaries, and fallopian tubes. It is usually caused by the spread of a vaginal or cervical infection. Having an untreated sexually transmitted disease (STD) is one of the most common risk factors.

PID symptoms aren't always noticeable but can include vaginal discharge or pelvic discomfort. In some cases, it can lead to infertility or a fertilized egg implanting outside of the uterus (ectopic pregnancy).

This article reviews the symptoms, causes, and potential complications of pelvic inflammatory disease. It also covers how it is diagnosed and treated.

PID Symptoms

Symptoms of PID can include:

• Aching or pain in the lower abdomen and pelvis
• Fever
• Unusual vaginal discharge with a foul odor
• Pain and/or bleeding during or shortly after sex
• Discomfort during urination
• Bleeding between periods

However, they are not always present. If they are, they are often mild or nonspecific. Because of this, PID can go undetected for years. Many people do not seek medical attention until health or reproductive complications occur.

If you do happen to recognize any signs of pelvic inflammatory disease, seek medical attention as soon as possible.

Complications

Acute complications include the development of a pelvic abscess (enclosed infection) or a major pelvic infection. Symptoms of this may include fever, chills, nausea, vomiting, or severe pelvic pain.

In some cases, it can lead to lead to sepsis, an extreme and potentially life-threatening response to an infection.

Longstanding untreated PID can result in serious health effects that affect reproductive health.

Women who have PID may be prone to ectopic pregnancy, which is a nonviable pregnancy in which a fertilized egg in the fallopian tube causes severe abdominal pain. An ectopic pregnancy can become a life-threatening medical emergency.

People who have had PID can also experience difficulty conceiving or carrying a child to term due to scarring and inflammation of the reproductive tract.

What Causes Pelvic Inflammatory Disease?

PID can happen as a consequence of STDs, bacterial vaginosis (BV), or as a complication of pelvic surgery or gynecologic procedures. Chlamydia and gonorrhea are the most common infections associated with PID.

Risk factors for developing PID include:

• Unprotected sex: Having multiple sexual partners increases the risk of vaginal and cervical infections, particularly if barrier methods of protection are not used every time.
• Untreated vaginal or cervical infections: Lingering infections can allow the spread of the infectious organism from the vagina up to the uterus, fallopian tubes, or ovaries.
• Younger age: People in their teens or early 20s who are sexually active are more prone to PID than those who are older than 25.
• Douching: Experts warn that douching can alter the protective flora (normal bacteria) and pH of the female reproductive tract. This alteration allows infections to thrive.
• Intrauterine devices (IUD): There is an increased risk of PID within the first few weeks after IUD insertion.

Infection and Inflammation

An infection can spread within a woman's reproductive system, causing inflammation and scarring. The scarring can narrow or block the fallopian tube, which prevents sperm from reaching the egg for fertilization. Infertility results when sperm cannot reach the egg.

If fertilization occurs in the fallopian tube (which is where it normally takes place), the narrowing may prevent the egg from reaching the uterus (which is where the fertilized egg needs to attach and grow for the remainder of pregnancy). The resulting effect, an ectopic pregnancy, occurs when the fertilized egg remains trapped in the fallopian tube.

Diagnosis

The diagnosis of PID generally involves a medical history, gynecologic exam, and diagnostic tests, such as ultrasound. Often, because there are no symptoms or few symptoms, diagnosis is made at a late stage when scarring has already occurred.

If you have PID, your healthcare provider will also evaluate you to identify the infectious organism.

Pelvic Examination

Several tests are used in the evaluation of PID. The first is a gynecologic examination (also called a pelvic examination), in which your healthcare provider will examine your vagina and cervix, typically with a light that helps in visualizing the area.

During your examination, you may have a Pap smear. The sample of cells taken from your cervix will then be sent to a laboratory so they can be examined under a microscope.

A fluid sample may also be taken and sent to a lab for a culture, which is a test that involves growing the bacteria so it can be identified.

Diagnostic Tests

Specialized diagnostic tests can help your healthcare provider visualize the structure of your reproductive organs, identifying areas of scarring throughout your reproductive tract.

• Transvaginal ultrasound: This exam involves the insertion of a camera into the vaginal opening. It can identify areas of inflammation or an abscess.
• Laparoscopy: This is a more invasive examination in which a camera is surgically inserted to identify structural changes, such as inflammation or scarring inside the reproductive tract and/or abdominal cavity.

PID Treatment

There are several approaches used for the treatment of PID, including antibiotics and surgery.

Oral (by mouth) antibiotics can be used to treat STDs and bacterial vaginitis before PID develops. And if infectious PID is detected, antibiotics can be used to target the infection. Typically the antibiotic is selected based on the organism grown in culture.

If you have an STD, your partner will need to be treated as well so that the infection will not be transmitted back and forth.

A severe infection that affects the bloodstream will need to be treated with intravenous (IV, directly in the vein) antibiotic treatment.

Surgery

Inflammation and scarring can cause infertility and the risk of ectopic pregnancy. Sometimes scars can be surgically treated, but this can increase the risk of adhesions—scars that can cause even further problems.

An abscess may require surgical removal, which is typically followed by oral or IV antibiotics.

Ectopic Pregnancy

An ectopic pregnancy may resolve without treatment, which means that you would have a miscarriage, typically with bleeding abdominal cramps. But because it can cause a life-threatening emergency, you will need to be monitored as the condition resolves.

If the ectopic pregnancy does not resolve on its own or if you develop a fever or signs of an emergency, you may be given medication to stop the pregnancy. Sometimes the fertilized egg must be surgically removed before it causes life-threatening problems, and this may require the removal of one of the ovaries or fallopian tubes as well.