Pelvic Inflammatory Disease

This is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries. Many women who develop pelvic inflammatory disease either experience no signs or symptoms or don’t seek treatment. Pelvic inflammatory disease may be detected only later when you have trouble getting pregnant or if you develop chronic pelvic pain.

Symptoms

Signs and symptoms of pelvic inflammatory disease may include:

Pain in your lower abdomen and pelvis
Heavy vaginal discharge with an unpleasant odor
Irregular menstrual bleeding
Pain during intercourse
Fever
Painful or difficult urination
PID may cause only minor signs and symptoms or none at all. PID with mild or no symptoms is especially common when the infection is due to chlamydia.

When to see a doctor

Go to the emergency room if you experience the following severe signs and symptoms of PID:

Severe pain low in your abdomen
Vomiting
Signs of shock, such as fainting
Fever, with a temperature higher than 101 F (38.3 C)

If your signs and symptoms aren’t severe, but they’re persistent, see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms appear, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

Causes

Pelvic inflammatory disease can be caused by a number of bacteria but are most often caused by gonorrhea or chlamydia infections. These bacteria are usually acquired during unprotected sex.

Less commonly, bacteria may enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen after intrauterine device (IUD) insertion, childbirth, miscarriage or abortion.

Risk Factors of Pelvic inflammatory disease

A number of factors may increase your risk of pelvic inflammatory disease, including:

Being a sexually active woman younger than 25 years old
Having multiple sexual partners
Being in a sexual relationship with a person who has more than one sex partner
Having sex without a condom
Having had an IUD inserted recently
Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and may mask symptoms that might otherwise cause you to seek early treatment
Having a history of pelvic inflammatory disease or a sexually transmitted infection

Complications

Untreated pelvic inflammatory disease may cause scar tissue and collections of infected fluid (abscesses) to develop in your fallopian tubes and damage your reproductive organs. Complications may include:

Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. In an ectopic pregnancy, the fertilized egg can’t make its way through the fallopian tube to implant in the uterus. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency surgery.
Infertility. PID may damage your reproductive organs and cause infertility — the inability to become pregnant. The more times you’ve had PID, the greater your risk of infertility. Delaying treatment for PID also dramatically increases your risk of infertility.
Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that may last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.

Tests and Diagnosis

Doctors diagnose pelvic inflammatory disease based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.

During the pelvic exam, your doctor uses a cotton swab to take samples from your vagina and cervix. The samples are sent to a lab for analysis to determine the organism that’s causing the infection.

To confirm the diagnosis or to determine how widespread the infection is, your doctor may recommend other tests, such as:

Ultrasound. This test uses sound waves to create images of your reproductive organs.
Endometrial biopsy. During this procedure, your doctor removes a small piece of your uterine lining (endometrium) for testing.
Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.

Treatment and Drugs

Treatment for pelvic inflammatory disease may include:

Antibiotics. Your doctor may prescribe a combination of antibiotics to start taking right away. After receiving your lab test results, your doctor may adjust the medications you’re taking to better match what’s causing the infection.

Usually, your doctor will request a follow-up visit in three days to make sure the treatment is working. Be sure to take all of your medication, even if you start to feel better after a few days. Antibiotic treatment can help prevent serious complications but can’t reverse any damage that’s already been done.

Treatment for your partner. To prevent reinfection with an STI, advise your sexual partner or partners to be examined and treated. Partners can be infected and not have any noticeable symptoms.
Temporary abstinence. Avoid sexual intercourse until treatment is completed and tests indicate that the infection has cleared in all partners.
More-serious cases

Outpatient treatment is adequate for treating most women with pelvic inflammatory disease. However, if you’re seriously ill, pregnant or haven’t responded to oral medications, you may need hospitalization. At the hospital, you may receive intravenous (IV) antibiotics, followed by antibiotics you take by mouth.

Surgery is rarely necessary. However, if an abscess ruptures or threatens to rupture, your doctor may drain it.

In addition, surgery may be performed on women who don’t respond to antibiotic treatment or who have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.