overview

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It most often occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries.

The signs and symptoms of pelvic inflammatory disease can be subtle or mild. Some women don’t experience any signs or symptoms. As a result, you might not realize you have it until you have trouble getting pregnant or you develop chronic pelvic pain.

symptoms

The signs and symptoms of pelvic inflammatory disease might be mild and difficult to recognize. Some women don’t have any signs or symptoms. When signs and symptoms of PID are present, they most often include:

Pain — ranging from mild to severe — in your lower abdomen and pelvis
Abnormal or heavy vaginal discharge that may have an unpleasant odor
Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
Pain during intercourse
Fever, sometimes with chills
Painful, frequent or difficult urination

Causes

Many types of bacteria can cause PID, but gonorrhea or chlamydia infections are the most common. These bacteria are usually acquired during unprotected sex.

Less commonly, bacteria can enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen during menstruation and after childbirth, miscarriage or abortion. Rarely, bacteria can also enter the reproductive tract during the insertion of an intrauterine device (IUD) — a form of long-term birth control — or any medical procedure that involves inserting instruments into the uterus.

Risk factors

A number of factors might 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
Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms
Having a history of pelvic inflammatory disease or a sexually transmitted infection
There is a small increased risk of PID after the insertion of an intrauterine device (IUD). This risk is generally confined to the first three weeks after insertion.

Diagnosis

There is no one test that can accurately diagnose pelvic inflammatory disease. Instead, your doctor will rely on a combination of findings from:

Your medical history. Your doctor will likely ask about your sexual habits, history of sexually transmitted infections and method of birth control.
Signs and symptoms. Tell your doctor about any symptoms you’re experiencing, even if they’re mild.
A pelvic exam. During the exam, your doctor will check your pelvic region for tenderness and swelling. Your doctor may also use cotton swabs to take fluid samples from your vagina and cervix. The samples will be tested at a lab for signs of infection and organisms such as gonorrhea and chlamydia.
Blood and urine tests. These tests may be used to test for pregnancy, HIV or other sexually transmitted infections, or to measure white blood cell counts or other markers of infection or inflammation.
Ultrasound. This test uses sound waves to create images of your reproductive organs.
If the diagnosis is still unclear, your doctor may recommend additional tests, such as:

Laparoscopy. During this procedure, your doctor inserts a thin, lighted instrument through a small incision in your abdomen to view your pelvic organs.
Endometrial biopsy. During this procedure, your doctor inserts a thin tube into the uterus to remove a small sample of endometrial tissue. The tissue is tested for signs of infection and inflammation.

Treatment

Prompt treatment with medicine can get rid of the infection that causes pelvic inflammatory disease. But there’s no way to reverse any scarring or damage to the reproductive tract that PID might have caused. Treatment for PID most often includes:

Antibiotics. Your doctor will prescribe a combination of antibiotics to start immediately. After receiving your lab test results, your doctor might adjust your prescription to better match what’s causing the infection. You’ll likely follow up with your doctor after 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.
Treatment for your partner. To prevent reinfection with an STI, your sexual partner or partners should be examined and treated. Infected partners might not have any noticeable symptoms.
Temporary abstinence. Avoid sexual intercourse until treatment is completed and symptoms have resolved.
If you’re pregnant, seriously ill, have a suspected abscess or haven’t responded to oral medications, you might need hospitalization. You might receive intravenous antibiotics, followed by antibiotics you take by mouth.

Surgery is rarely needed. However, if an abscess ruptures or threatens to rupture, your doctor might drain it. You might also need surgery if you don’t respond to antibiotic treatment or have a questionable diagnosis, such as when one or more of the signs or symptoms of PID are absent.