Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection and inflammation of the upper female reproductive organs that are situated in the pelvis. These may include the womb, called the uterus; the tubes that fan out from the womb, called the fallopian tubes; or the egg producing gonads, called the ovaries.

As the inflammation gets severe, the fallopian tubes and ovaries may form an enlarged and sticky bag of pus, called a tubo-ovarian abscess. The infection may even spread to the abdominal cavity and its contents and lead to an inflammation called peritonitis.

PID is a common condition. Each year more than 750,000 women experience an episode of PID in the USA.

Mode of infection

Pelvic Inflammatory Disease is an ascending infection, i.e., it is an infection where the germs travel way up the birth canal, called vagina to affect the other upper reproductive organs. The resultant inflammation in the uterus in called endometritis, one in the fallopian tubes is called salpingitis, and that in the ovaries is called oophoritis.

The sexually transmitted diseases (STDs) that are notorious for causing PID are gonorrhea and Chlamydia. PID can develop anytime within few days to months after a woman has suffered from a STD.

Infections like bacterial vaginosis, which are not sexually transmitted, can also lead to PID. Many of these infections can be asymptomatic, and hence may escape attention.

Risk Factors

PID occurs in sexually active women. The risks are higher if the woman is young, has multiple sex partners, does not use a barrier contraceptive like condoms or diaphragms, and comes from a lower socio-economic class.

The risk is high even if the partner of a woman has multiple partners. Women who use an intra uterine device (IUD) for contraception have an increased risk for PID near insertion. The risk is high in women who have already are suffering from a sexually transmitted disease like gonorrhea, HIV, or any other sexual infection. One episode of PID increases the risk of another one in future if not treated well.

PID can be deceptively silent and may not cause any complaints. Some women may experience only mild or non-specific complaints. The commonest complaint in women suffering from PID is pain, which may vary in severity and type depending upon the extent of infection. Other common problems caused by PID are:

  • Abnormal menstrual bleeding
  • Vaginal discharge
  • Frequent and painful urination
  • Fever
  • Chills
  • Nausea
  • Pain during intercourse

If you are a woman of childbearing age and experience any of these symptoms, you should seek medical help.

As soon as you think you might be developing a PID, see a doctor without any further delay. Share proper details of your sexual activities and preferences, and partners.

Do not conceal anything or feel inhibitions to discuss openly what problems you have. Complete all the tests you are advised. Refrain from sex and talk to your sex partner(s) and have them investigated too.

The health care provider may examine your pelvis and advise you some investigations. The pelvic examination may cause pain.

The vaginal secretions may be collected to examine the discharges for infection. Some blood tests may be done.

You may need to undergo an ultrasound to help the doctor look at your internal reproductive organs. Usually, it helps to diagnose a PID if pus is seen in the pelvis. If the diagnosis is not established with an ultrasound and a woman does not respond to treatment, the doctor may advise a laparoscopy. A flexible tube with a mounted camera is inserted through a small incision in the abdomen and the organs are viewed and samples of fluid (if any) are collected for laboratory examination.

PID needs proper and immediate treatment. Antibiotics are prescribed depending upon the type of infection suspected. Two or more antibiotics may be prescribed in some infections. It is important to take medicines even if there are not many symptoms and complete the entire prescribed schedule for pelvic inflammatory disease treatment even if the symptoms subside early with treatment.

When the infection is difficult to diagnose, severe, or if a woman is pregnant, a hospitalization may be required to undergo treatment. If the tests reveal a localized big abscess, it may be aspirated or drained by a surgical procedure.

Surgery may be required if the organs in the pelvis are found glued together on investigations. Treatment in PID usually yields good results.

You should discuss with your partner(s) and have them treated. A partner may need treatment even if there are no symptoms. Do not have sex with a partner who has not been treated.

PID if not treated well, can lead to complications. You may develop a constant ache in the abdomen. This can vary from mild to severe and can be distressing. The worst consequence of PID can be infertility. You may not be able to conceive or bear children if PID is not treated well.

One of the small openings of the fallopian tubes may be blocked. The lining of the uterus or tubes or the ovaries may be irreversibly damaged. PID increases the chances of ectopic pregnancy where the developing baby implants in the tubes or any other site outside the uterus. This is a medical emergency and needs immediate surgery.

The inflamed internal organs in PID may get glued together due to sticky pus and over a period of time may get scarred. This leads to a condition called ‘frozen pelvis’ where it is not able to visualize and demarcate the internal organs individually.

  • Practice safe sex to avoid STDs.
  • Have only one sex partner.
  • Make sure your partner has sex with only you and nobody else.
  • Use condoms every time you have sex. Use them even if you are using other birth control measures like pills.
  • If you cannot limit your sex partners, you should undergo regular medical examinations for STDs.
  • Simple urine and vaginal tests can help to detect any sexual infections.
  • Caution, consistent and correct use of condoms, and proper medical care can help to prevent STDs and PID.