Pelvic inflammatory disease

female reproductive organs

Pelvic inflammatory disease (PID) generally refers to infection and inflammation of the uterus, fallopian tubes and/or ovaries in women, and can result in permanent damage to a woman’s reproductive organs.

Symptoms of PID

It can sometimes be difficult to tell if you have PID, as some women may have severe symptoms while others may have mild or even no symptoms at all.

You may have:

  • abnormal vaginal bleeding (including bleeding between periods, bleeding after sex and heavy menstrual bleeding);
  • pain or tenderness in your lower abdomen;
  • pain during sex;
  • backache;
  • unusual discharge from the vagina (such as discharge that has a bad odour);
  • pain or burning when urinating; or
  • fever, chills, nausea or vomiting.

If you have any of these symptoms, see your doctor.

Complications

Complications of pelvic inflammatory disease include:

  • tubal infertility (inability to get pregnant due to scarring of the fallopian tubes);
  • an increased risk of ectopic pregnancy (a pregnancy that implants outside the uterus – most often in the fallopian tubes); and
  • chronic (ongoing) pelvic pain.

Complications are more likely if there is a delay in treatment for PID, or if you have PID more than once.

Causes of PID

Pelvic inflammatory disease is generally caused by bacteria from the vagina or cervix spreading to the upper female reproductive organs (uterus, fallopian tubes and ovaries).

The infection may be sexually transmitted (most commonly chlamydia or gonorrhoea) or the result of overgrowth of certain types of vaginal bacteria.

Sometimes PID occurs following childbirth or a miscarriage, or after procedures such as abortion or having an IUD inserted.

Risk factors

Factors that increase your risk of PID include:

  • having unprotected sex;
  • having more than one sexual partner;
  • having a sex partner who has more than one sexual partner;
  • being younger than 25 years of age;
  • regular vaginal douching (which disturbs the balance of bacteria in the vagina);
  • recent gynaecological procedures such as dilation and curettage (D and C) or hysteroscopy; and
  • recent insertion of an intrauterine device (IUD).

Tests and diagnosis

PID can be difficult to diagnose, as symptoms vary significantly from woman to woman, with some women experiencing no symptoms at all.

Your doctor will ask about your symptoms and perform an examination, including a pelvic examination. Your doctor will take swab samples from your vagina and cervix during the pelvic examination to determine the type of micro-organism that is causing the infection. A urine test may also be performed, to test specifically for gonorrhoea, chlamydia and a type of bacteria called Mycoplasma genitalium.

Sometimes additional tests, such as a pelvic ultrasound, may be needed to determine the extent of the infection.

Chlamydia infection is one of the most common causes of blocked fallopian tubes. Women infected with chlamydia often have no symptoms early in the infection, so if you are sexually active, you should have your doctor check for chlamydia at least once a year. Sexually active men should also have regular checks for chlamydia, even if they do not have any symptoms, so that they do not pass the infection on to their partner.

Treatment

Treatment involves antibiotics – usually a combination of several antibiotics is needed. The type of antibiotics will depend on the cause of the infection. In some cases, testing may be needed after treatment to confirm the infection has been effectively eradicated.

All recent sex partners (those from the last 6 months) should be checked and treated by a doctor, especially if your PID is the result of a sexually transmitted infection. It’s important that you do not have sexual intercourse again until you (and any affected sex partners) have completed the course of treatment.

Prevention

If you are in a sexual relationship with only one partner, you have very little risk of PID.

If you have multiple partners, you can guard against PID by using condoms during sex and having regular STI checks.

Also, avoid vaginal douching, which can disturb the natural balance of vaginal bacteria.

Last Reviewed: 27 November 2013
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References

1. Pelvic inflammatory disease (revised June 2010). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Jul. http://online.tg.org.au/complete/ (accessed Oct 2013).
2. Centers for Disease Control and Prevention (CDC). Pelvic inflammatory disease (PID) – CDC fact sheet (updated 28 Sep 2011). http://www.cdc.gov/std/pid/stdfact-pid.htm (accessed Oct 2013).
3. Family Planning NSW. Pelvic inflammatory disease (PID) (updated Nov 2012). http://www.fpnsw.org.au/518858_8.html (accessed Oct 2013).
4. MayoClinic.com. Pelvic inflammatory disease (PID) (updated 24 May 2011). http://www.mayoclinic.com/health/pelvic-inflammatory-disease/DS00402 (accessed Oct 2013).
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