Pelvic inflammatory disease is an inflammation of the female reproductive organs, including the uterus, or womb, the fallopian tubes, the ovaries, or a combination. It may lead to scar formations with fibrous bands that form between tissues and organs.
Most cases of pelvic inflammatory disease (PID) are caused by an infection in the vagina or cervix that spreads. PID can refer to bacteria, fungal, or parasitic infections, but a bacterial infection is more likely.
Sexually transmitted infections (STIs) are a common cause of PID, but infection can occur after childbirth, an abortion, or a miscarriage, or as a result of using an intrauterine device (IUD), which is a form of birth control.
PID can lead to complications, including chronic, persistent, pelvic pain, ectopic pregnancy, and infertility.
According to the American Family of Physicians, 750,000 cases of PID are diagnosed each year in the U.S.
The Centers for Disease Control and Prevention (CDC) estimate that 1 in 8 women who have been diagnosed with PID experience difficulties becoming pregnant.
Contents of this article:
Symptoms of pelvic inflammatory disease
Many women with PID have no symptoms. If symptoms appear, they can vary from mild to severe. However, the repercussions of PID can be serious.
Pelvic inflammatory disease can cause severe pain in the pelvic area.
Possible symptoms include:
- Pain, especially in the pelvic area, which can be severe
- Irregular periods, or menstruation
- Pain in the lower back and the rectum
- Painful sexual intercourse
- Unusual vaginal discharge
Many women do not have any symptoms, and they do not realize they have had a PID until they seek medical advice for infertility problems.
Causes of pelvic inflammatory disease
PID usually starts with an infection that begins in the vagina and spreads to the cervix. It can then move to the fallopian tubes and the ovaries.
Often, more than one type of bacteria may be causing the infection.
The American Family Physician estimate that between 80 percent and 90 percent of women with chlamydia and 10 percent of those with gonorrhea have no symptoms. Some 10 percent to 15 percent of women with chlamydia or gonorrhea go on to develop PID as a secondary infection.
Childbirth, abortion or miscarriage can lead to PID, if bacteria enter the vagina. The infection can spread more easily if the cervix is not fully closed.
An IUD, which is a form of birth control that is placed into the uterus, can increase the risk of infection, and this may lead to PID.
An endometrial biopsy, during which a sample of tissue is taken for analysis, has a risk of infection and subsequent PID.
Appendicitis very slightly increases the risk of developing PID, if the infection spreads from the appendix to the pelvis.
Women who are sexually active and less than 25 years of age, have several sexual partners, or do not use barrier contraceptives, have a higher chance of developing PID. It is most common among women aged 15 to 29 years.
Complications of pelvic inflammatory disease
Complications can arise if the individual does not seek early treatment, for example:
- Recurrence of PID, with a risk of chronic pelvic pain
- Abscesses in the fallopian tubes, ovaries, and the entrance to the vagina
- Ectopic pregnancy, in which the embryo develops outside the uterus, or womb
- Infertility due to scarring in the fallopian tubes.
It is important to seek medical advice as soon as possible, if PID may be present.
A woman who has had PID has a 20 percent chance of infertility due to scarring of the fallopian tubes and a 9 percent risk of a future ectopic pregnancy. The odds of developing chronic pelvic pain are 18 percent.
How is pelvic inflammatory disease diagnosed?
A physician will ask questions about symptoms and will carry out a gynecological exam. A pelvic exam will usually be performed to look for tenderness of the pelvic organs.
A swab may be taken from the cervix, and maybe from the urethra. The urethra is the tube from the bladder through which urine flows.
There may be blood and urine tests.
A laparoscope is a long, thin tube that the doctor can push through the wall of the abdomen to view the area. If necessary, tissue samples can be taken through it.
Treatment for pelvic inflammatory disease
The earlier the treatment, the lower the risk will be of developing complications, such as infertility.
A PID can have serious repercussions for the reproductive system, if it is not treated.
Antibiotics are an important form of treatment.
PID is often caused by more than just one type of bacteria at any one time, so doctors may prescribe two antibiotics that the patient will take together.
When the doctor knows which bacteria are causing the disease, therapy may become more targeted.
Antibiotics for PID include cefoxitin, metronidazole, ceftriaxone, and doxycycline. A course of antibiotics usually lasts 14 days.
If the antibiotics do not make a difference within 3 days, the patient should seek further help. She may receive intravenous antibiotic therapy or a change of medication.
Patients with very severe symptoms will remain in the hospital, and receive their medication intravenously.
Surgery may be needed if there is scarring on the fallopian tubes or if an abscess needs draining. This may be keyhole surgery, or it may involve removal of one or both fallopian tubes.
Doctors are reluctant to remove both fallopian tubes, because the woman will not be able to become pregnant naturally.
The woman's sexual partner may need to seek treatment for an STI. If the partner has an STI, there is a serious risk of recurrence if it goes untreated.
The patient should refrain from sex until the treatment is completed.
Preventing pelvic inflammatory disease
PID can become a serious condition, but there are some ways to minimize the risk:
- Have regular screening, especially for those who have multiple sex partners
- Make sure sexual partners are tested for infections and STIs
- Avoid douching, because this increases the risk of developing PID
- After childbirth, miscarriage or abortion women should wait a while before having sex, until the cervix closes properly.
Using a condom or cervical cap and practicing safe sex are important in preventing PID.Written by Christian Nordqvist