Sexual Health STDs More STDs An Overview of Pelvic Inflammatory Disease (PID) When a vaginal infection spreads through a woman's reproductive tract By Elizabeth Boskey, PhD facebook twitter linkedin 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 Elizabeth Boskey, PhD Medically reviewed by Medically reviewed by Matthew Wosnitzer, MD on December 28, 2020 twitter linkedin Matthew Wosnitzer, MD, is board-certified in urology. He is an attending physician at Yale New Haven Health System, Northeast Medical Group and teaches at the Frank Netter School of Medicine. Learn about our Medical Review Board Matthew Wosnitzer, MD on December 28, 2020 Print Table of Contents View All Symptoms Causes Diagnosis Treatment Pelvic inflammatory disease (PID) is a type of inflammatory infection that affects a woman's reproductive organs in the pelvis. 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 can cause vaginal discharge or pelvic discomfort, but it does not always cause noticeable effects. However, it increases the risk of infertility and ectopic pregnancy (a tubal pregnancy). A PID can be detected with clinical examination, and it is usually treated with antibiotics. FatCamera / Getty Images Symptoms Not all women with PID have noticeable symptoms. In fact, it can go undetected for years, eventually causing health or reproductive complications. Sometimes symptoms can occur, but they are often mild or nonspecific—and because of this, many women do not seek medical attention for the chronic effects of PID until complications occur. That is why it is important to recognize the signs of this condition and to seek medical attention as soon as you begin to experience effects. Symptoms of PID can include: Aching in the lower abdomen and pelvisExcess vaginal discharge with a foul odorPain or bleeding during or shortly after sexDiscomfort during urinationLower back painIrregular periods With PID, these symptoms can come and go even if the infection or inflammation continues to affect the body. Acute Infections Acute complications include the development of a pelvic abscess (enclosed infection) or a major pelvic infection. Symptoms may include fever, chills, nausea, vomiting, or severe pelvic pain. An infection can spread to the bloodstream, potentially causes sepsis. Complications Longstanding untreated PID can result in serious health effects that affect a woman's 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. Women who have had PID can also experience difficulty conceiving or carrying a child to term due to scarring and inflammation of the reproductive tract. Causes PID is an infection of the uterus, ovaries, and fallopian tubes. It 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/unsafe 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: Teenagers who are sexually active are more prone to PID than women who are in their 20's or older.Douching: Experts warn that douching can alter the protective flora (normal bacteria) and pH of a woman's 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 most women have no symptoms or few symptoms, diagnosis is made at a late stage, when scarring has already occurred. If you have PID, your doctor 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 doctor 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 and/or a fluid sample. A Pap smear is sent to a laboratory so that the cells sampled from your cervix can be examined under a microscope. A fluid sample may be sent to a laboratory for a culture, which is a test that is used to grow and identify a bacterial infection. What to Expect From a Pelvic Examination Diagnostic Tests Specialized diagnostic tests can help your doctor visualize the structure of your reproductive organs, identifying areas of scarring throughout your reproductive tract (vagina, cervix, uterus, fallopian tubes, and ovaries). 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. Treatment There are several approaches used for the treatment of PID, including antibiotics and surgery. 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 surgery can increase the risk of adhesions, which is a type of scar that can cause even further problems. An abscess may require surgical removal, and the procedure is typically followed by oral (by mouth) 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. Keep in mind that an ectopic pregnancy is not viable because a baby cannot grow unless it is in the uterus. A Word From Verywell Worldwide, PID is one of the leading causes of ectopic pregnancy and preventable infertility in women. Strategies for prevention include safe sex and screening and prompt treatment for STDs. Unless your doctor instructs you to douche, you should avoid this practice because it can be harmful to your health and increase the risk of developing PID. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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). [Updated 2019 Feb 11]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. 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 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 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 Dulin JD, Akers MC. Pelvic inflammatory disease and sepsis. Crit Care Nurs Clin North Am. 2003;15(1):63-70. 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 Martino JL, Vermund SH. Vaginal douching: evidence for risks or benefits to women's health. Epidemiol Rev. 2002;24(2):109-24. doi:10.1093/epirev/mxf004 Hubacher D. Intrauterine devices & infection: review of the literature. Indian J Med Res. 2014;140 Suppl:S53-7. 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 Bourne PA, Charles CA, Francis CG, South-bourne N, Peters R. Perception, attitude and practices of women towards pelvic examination and Pap smear in Jamaica. N Am J Med Sci. 2010;2(10):478-86. doi:10.4297/najms.2010.2478 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. [Updated 2019 Mar 10]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. 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.