what is pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) is characterized by infection of the female reproductive organs, such as the uterus, fallopian tubes, and ovaries. PID occurs when bacteria move from the vagina and cervix upward into the uterus, ovaries, or fallopian tubes. The bacteria can lead to an abscess in a fallopian tube or ovary.
Long-term problems can occur if PID is not treated promptly. It is mostly acquired through unsafe sexual practices and is one of the most serious consequences of sexually transmitted diseases (STD). It mostly affects sexually active women aged 15 to 24. PID can cause permanent damage to the female reproductive system, and is one of the leading causes of infertility.
What are causes of PID
PID can occur when your cervix is exposed to an STD, such as chlamydia or gonorrhoea. The cervix loses its ability to protect the internal organs from bacteria and the infection eventually spreads to your uterus, ovaries, and fallopian tubes. Ninety percent of PID occurs as a result of untreated chlamydia and gonorrhoea. When a woman is infected with gonorrhea or chlamydia and does not receive treatment, it can take anywhere from a few days to a few weeks before she develops PID. PID also can be caused by infections that are not sexually transmitted, such as bacterial vaginosis. Sexual practices that involve multiple partners and unprotected sex increase your chances of acquiring STDs, which can in turn lead to PID. Some of the other causes include:
- Intrauterine device (IUD) use
- Regular douching
- Previous history of PID or STD
Who is at risk of PID
PID is most common among young women, however it can occur at any age in women who are sexually active. Those younger than age 25 years are more likely to develop PID. Women with the following risk factors also are more likely to develop PID:
Some research suggests that women who douche frequently are at increased risk of PID. Douching may make it easier for the bacteria that cause PID to grow. It also may push the bacteria upward to the uterus and fallopian tubes from the vagina. For this and other reasons, douching is not recommended.
What are symptoms of PID
PID can show minor symptoms or no symptoms at all (common with chlamydial infection). Many cases are not recognized by women or their gynecologists. Symptoms can often vary, but may include:
- Dull pain in lower abdomen (tummy) and pelvis (often a mild ache).
- Pain in the upper right abdomen.
- Green or yellow vaginal discharge, having a distinct and often unpleasant odour.
- Pain during urination.
- Irregular menses.
- Fever or chills.
- Nausea, vomiting or diarrhoea.
- Pain in the lower back.
- Discomfort or pain during sex that’s felt deep inside the pelvis.
Having one of these signs or symptoms does not mean that you have PID. It could be a sign of another serious problem, such as appendicitis or ectopic pregnancy. If you notice any of these symptoms, it is important to stop having intercourse and visit your doctor immediately, as prompt treatment is vital for PID.
Complications of PID
Left untreated, PID can lead to serious, long-term problems:
- Infertility. One in ten women with PID becomes infertile. PID can cause scarring of the fallopian tubes. This scarring can block the tubes and prevent an egg from being fertilized.
- Ectopic pregnancy. Scarring from PID also can prevent a fertilized egg from moving into the uterus. Instead, it can begin to grow in the fallopian tube. The tube may rupture (break) and cause life-threatening bleeding into the abdomen and pelvis. Emergency surgery may be needed if the ectopic pregnancy is not diagnosed early.
- Chronic pelvic pain. PID may lead to long-lasting pelvic pain.
Women who have had delayed treatment or had repeated episodes of PID are most at risk. However, most women treated for PID are still able to get pregnant without any problems.
How is PID diagnosed?
Based on your signs and symptoms, your gynecologist may perform a pelvic examination, obtain a sample your vaginal discharge, and perform cervical cultures and urine tests. Samples may be obtained from your cervix and vagina using a cotton swab, and sent to the laboratory to identify the bacteria causing the infection.Your gynecologist may also recommend the following tests to confirm and determine the extent of your infection.
- Blood tests
- Pelvic ultrasound, where sound waves are used to relay images of your reproductive organs
- Endometrial biopsy
- Laparoscopy, where a thin lighted tube with a camera is inserted through a small cut in your abdomen to examine your pelvic organs
How is PID treated?
PID can be treated. However, treatment cannot reverse the scarring caused by the infection. The longer the infection goes untreated, the greater the risk for long-term problems, such as infertility.
PID is treated first with antibiotics. Antibiotics alone usually can get rid of the infection. Two or more antibiotics may be prescribed. They can be given as pills, through a tube inserted in a vein (intravenous line), or by injection. Gynecologist may schedule a follow-up visit 2–3 days after treatment to check your progress. Sometimes the symptoms go away before the infection is cured. If they do, you still should take all of the medicine for as long as it is prescribed.
Some women may need to be treated in a hospital. Hospitalization may be recommended for women who
- do not have a clear diagnosis
- are pregnant
- must take antibiotics intravenously
- are severely ill
- have nausea and vomiting
- have a high fever
- have an abscess in a fallopian tube or ovary
In certain situations, such as when an abscess is found, surgery may be needed.
A woman’s sex partners must be treated. Women with PID may have partners who have gonorrhea or chlamydia. A person can have these STIs even if there are no signs of illness.
How can PID be prevented?
Prevention is the best way to deal with PID.
- Avoid unsafe sexual practices, multiple partners, and use barrier methods such as condoms and spermicides.
- Avoid IUD if you have multiple partners.
- Watch for symptoms and be prompt to get treatment.
- Have regular follow up with your doctor, as infections identified during the early stages can be prevented from spreading to your reproductive organs.
- Avoid douching, as douching disturbs the fragile balance of bacteria in your vagina, mask your vaginal discharge, and push the bacteria up into the genital tract.