Sexual Health STIs More STDs An Overview of Pelvic Inflammatory Disease (PID) When a vaginal infection spreads through a woman's reproductive tract By Elizabeth Boskey, PhD Elizabeth Boskey, PhD Facebook LinkedIn Twitter Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. Learn about our editorial process Updated on January 11, 2023 Medically reviewed by Matthew Wosnitzer, MD Medically reviewed by Matthew Wosnitzer, MD LinkedIn Twitter Matthew Wosnitzer, MD, is a board-certified urologic surgeon and physician scientist. He specializes in male infertility. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment 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. Verywell / Laura Porter PID Symptoms Symptoms of PID can include: Aching or pain in the lower abdomen and pelvisFeverUnusual vaginal discharge with a foul odorPain and/or bleeding during or shortly after sexDiscomfort during urinationBleeding 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. With PID, symptoms can come and go even—if the infection or inflammation continues to affect the body. 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. What to Expect From a Pelvic Examination 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. An ectopic pregnancy is not viable because a baby cannot grow unless it is in the uterus. 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. 13 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Jennings LK, Krywko DM. Pelvic inflammatory disease (PID). In: StatPearls. Treasure Island (FL): StatPearls Publishing. Centers for Disease Control and Prevention. Pelvic inflammatory disease (PID)-CDC basic fact sheet. Wiesenfeld HC, Hillier SL, Meyn LA, Amortegui AJ, Sweet RL. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol. 2012;120(1):37-43. doi:10.1097/AOG.0b013e31825a6bc9 Spencer TH, Umeh PO, Irokanulo E, et al. Bacterial isolates associated with pelvic inflammatory disease among female patients attending some hospitals in Abuja, Nigeria. Afr J Infect Dis. 2014;8(1):9-13. doi:10.4314/ajid.v8i1.3 Kornete A, Grabe Z. Pelvic inflammatory disease and sepsis: the diagnostic challenge. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2019;234:e62. doi:10.1016/j.ejogrb.2018.08.291 Trent M. Pelvic inflammatory disease. Pediatr Rev. 2013;34(4):163-72. doi:10.1542/pir.34-4-163 Huang CC, Huang CC, Lin SY, et al. Association of pelvic inflammatory disease (PID) with ectopic pregnancy and preterm labor in Taiwan: A nationwide population-based retrospective cohort study. PLoS ONE. 2019;14(8):e0219351. doi:10.1371/journal.pone.0219351 Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 2013;27(4):793-809. doi:10.1016/j.idc.2013.08.004 Das BB, Ronda J, Trent M. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infect Drug Resist. 2016;9:191-7. doi:10.2147/IDR.S91260 Johns Hopkins Medicine. Pelvic Inflammatory Disease (PID). Romosan G, Valentin L. The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature. Arch Gynecol Obstet. 2014;289(4):705-14. doi:10.1007/s00404-013-3091-6 Shigemi D, Matsui H, Fushimi K, Yasunaga H. Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess. Obstet Gynecol. 2019;133(6):1224-1230. doi:10.1097/AOG.0000000000003259 Mummert T, Gnugnoli DM. Ectopic Pregnancy. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Additional Reading Anyalechi GE, Hong J, Kreisel K, Torrone E, Boulet S, Gorwitz R et al. Self-Reported Infertility and Associated Pelvic Inflammatory Disease Among Women of Reproductive Age-National Health and Nutrition Examination Survey, United States, 2013-2016. Sex Transm Dis. 2019 Jul;46(7):446-451. doi:10.1097/OLQ.0000000000000996 Savaris RF, Fuhrich DG, Duarte RV, Franik S, Ross JDC. Antibiotic therapy for pelvic inflammatory disease: an abridged version of a Cochrane systematic review and meta-analysis of randomised controlled trials. Sex Transm Infect. 2019 Feb;95(1):21-27. doi:10.1136/sextrans-2018-053693. Epub 2018 Oct 19. Shigemi D, Matsui H, Fushimi K, Yasunaga H. Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess. Obstet Gynecol. 2019 Jun;133(6):1224-1230. doi:10.1097/AOG.0000000000003259 By Elizabeth Boskey, PhD Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. 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