Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection or inflammation of the female reproductive system. It can affect one or more organs, including the cervix, the uterus (womb) and its lining (the endometrium), the fallopian tubes and the ovaries.

PID can cause ongoing pelvic pain in some people, while in others the symptoms are mild or silent, which means some people may not even know they have it. PID can affect anyone with these organs, but sexually active women in their 20s are commonly affected. The infection usually develops in stages, starting in the cervix, then spreading to the endometrium and then the fallopian tubes.

PID is treatable, but if left untreated it can lead to long-term scarring, infertility, ectopic pregnancy and other damage to the reproductive system.

Causes of PID#

PID is usually caused by a bacterial infection. The most common causes are sexually transmissible infections (STIs), mainly:

• chlamydia
• gonorrhoea
• mycoplasma genitalium

Other causes of PID include:

• a ruptured (burst) appendix
• bowel infection (such as gastroenteritis)
• vaginal infections (such as bacterial vaginosis)
• some surgical procedures, such as dilatation and curettage (D&C), insertion of an intrauterine device (IUD) or surgical abortion

Symptoms of PID#

For some people it can be hard to tell whether they have PID, because there may not be any obvious symptoms. That is why regular health checks and STI testing are important if you are sexually active.

When present, signs and symptoms of PID can include:

• lower abdominal pain or tenderness that may worsen with movement
• menstrual problems, such as painful periods, ovulation pain or heavy discharge
• a change in the smell, colour or amount of vaginal discharge (such as an unpleasant or ‘fishy’ odour)
• bleeding or spotting after sex
• painful sex (dyspareunia)
• fever
• nausea and vomiting

If left untreated, PID can cause long-term scarring and blockage of the fallopian tubes.

PID and fertility#

PID can affect your fertility in several ways:

• One episode of PID can double your risk of tubal infertility.
• One episode increases the risk of ectopic pregnancy (where the fetus develops outside the uterus) sevenfold. This can happen because the fertilised egg is unable to pass through a scarred or blocked fallopian tube to the uterus.
• If you have had three or more episodes of PID, your risk of fallopian tube blockage increases significantly.

Diagnosis of PID#

If you have any symptoms, see your doctor. They will do a physical examination of your pelvic area to check for tenderness and swelling, and test for possible causes such as chlamydia and gonorrhoea.

Depending on the suspected cause, diagnosis may include:

• blood tests
• a urine test
• swabs of the vagina and cervix
• an ultrasound (pelvic or transvaginal)
• laparoscopy, sometimes needed to correctly diagnose PID; a thin tube with a small camera at the end (an endoscope) is inserted through the navel to view the reproductive organs, and a sample of tissue (biopsy) may be taken
• a biopsy

Laparoscopy is performed under general anaesthetic.

Treatment of PID#

Early treatment of PID may reduce the risk of complications. If it is not treated, persistent pelvic pain can develop, usually due to extensive scarring.

Treatment usually involves:

• a combination of antibiotics that act against a range of organisms, usually taken for about two weeks
• avoiding sexual contact until you have finished treatment and have no symptoms
• testing your partners and treating them if needed
• removal of an IUD, if it is the cause, with your doctor suggesting other forms of contraception

In some cases, a stay in hospital is needed, for example with severe symptoms, an uncertain diagnosis, abscesses, or if you do not respond to recommended treatment.

Preventing PID#

To help reduce your risk of PID and of passing on the bacteria that cause it:

• Practise safe sex by using condoms (external and internal) during any form of sexual contact, including vaginal, oral and anal sex.
• If you are sexually active, get tested for STIs at least once a year, and more often if you have multiple or casual partners over a short period.
• See your doctor or a health clinic if you notice any symptoms or suspect you may have PID.
• If you are planning to start a family or are pregnant, get tested for STIs.
• If you have an STI, let your sexual partners know so they can be tested and treated.

If you feel uncomfortable telling partners yourself, your doctor or a sexual health service can help, and in many places partners can be notified anonymously.

Key points#

• PID may have no obvious symptoms; when present they can include lower abdominal pain, abnormal discharge, painful sex, fever, and nausea and vomiting.
• If left untreated, PID can cause long-term scarring and blockage of the fallopian tubes.
• Scarring can prevent a fertilised egg from passing through the fallopian tube to the uterus.
• One episode of PID increases the risk of ectopic pregnancy (where the fetus develops outside the uterus) sevenfold.
• If you have any symptoms, see your doctor.

Where to get help#