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.
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Before Pelvic Inflammatory Disease (PID) Treatment
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
When to see a doctor
See your doctor or seek urgent medical care if you experience:
. Severe pain low in your abdomen
. Nausea and vomiting, with an inability to keep anything down
. Fever, with a temperature higher than 101 F (38.3 C)
. Foul vaginal discharge
If you have signs and symptoms of PID that aren't severe, still see your doctor as soon as possible. Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can also be symptoms of a sexually transmitted infection (STI). If these signs and symptoms occur, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.
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.
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.
Untreated pelvic inflammatory disease might cause scar tissue and pockets of infected fluid (abscesses) to develop in the reproductive tract. These can cause permanent damage to the reproductive organs.
Complications from this damage might include:
. Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy. An ectopic pregnancy can occur when untreated PID has caused scar tissue to develop in the fallopian tubes. The scar tissue prevents the fertilized egg from making its way through the fallopian tube to implant in the uterus. Instead, the egg implants in the fallopian tube. Ectopic pregnancies can cause massive, life-threatening bleeding and require emergency medical attention.
. Infertility. Damage to your reproductive organs may 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 might last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.
. Tubo-ovarian abscess. PID might cause an abscess — a collection of pus — to form in your reproductive tract. Most commonly, abscesses affect the fallopian tubes and ovaries, but they can also develop in the uterus or in other pelvic organs. If an abscess is left untreated, you could develop a life-threatening infection.
To reduce your risk of pelvic inflammatory disease:
. Practice safe sex. Use condoms every time you have sex, limit your number of partners and ask about a potential partner's sexual history.
. Talk to your doctor about contraception. Many forms of contraception do not protect against the development of PID. Using barrier methods, such as a condom, helps to reduce your risk. Even if you take birth control pills, use a condom every time you have sex with a new partner to protect against STIs.
. Get tested. If you're at risk of an STI, make an appointment with your doctor for testing. Set up a regular screening schedule with your doctor if needed. Early treatment of an STI gives you the best chance of avoiding PID.
. Request that your partner be tested. If you have pelvic inflammatory disease or an STI, advise your partner to be tested and treated. This can prevent the spread of STIs and possible recurrence of PID.
. Don't douche. Douching upsets the balance of bacteria in your vagina.
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.
During Pelvic Inflammatory Disease (PID) 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.
After Pelvic Inflammatory Disease (PID) Treatment
How can I take care of myself if I have pelvic inflammatory disease?
If you feel symptoms of PID, see your healthcare provider right away. And if you had unprotected sex, it’s a good idea to talk to your provider, even if you don’t feel symptoms. The sooner you get treated, the more likely it will be effective. Prompt treatment also reduces your risk of serious complications.
Other tips for taking care of yourself:
. Avoid douching to prevent pushing bacteria upward from your vagina into your uterus and fallopian tubes.
. Return to your healthcare provider a few days after starting medication to make sure it’s working.
. Take all your medicine as directed.
. Use condoms or dental dams every time you have sex to protect yourself from infections.
. Wait one week after you (and your partner) have finished medication to resume your sex life.
If I had pelvic inflammatory disease, will I have trouble getting pregnant?
PID can affect fertility. Of the women who had PID, studies found that 1 in 8 had difficulty getting pregnant. People who had repeat infections had a harder time getting pregnant.
How does PID affect fertility?
An egg needs to travel from your ovary, down the fallopian tube and into the uterus (womb). Then the sperm can fertilize it. But bacteria from PID can cause scarring on your fallopian tubes. The scar tissue makes it harder for the egg to get where it needs to go.