PELVIC INFLAMMATORY DISEASE

What is Pelvic Inflammatory Disease (PID)?

Pelvic inflammatory disease, or PID, is an infection of a woman's pelvic organs (uterus, fallopian tubes, and ovaries). PID can affect the fallopian tubes (the tubes that carry eggs from the ovary to the uterus, or womb). It can also involve the tissues in and near the uterus and ovaries.

PID can be treated and cured with antibiotics. If left untreated, PID can lead to serious problems like infertility (not being able to get pregnant), ectopic pregnancy (pregnancy in the fallopian tube instead of the uterus), constant pelvic pain, and other problems.

PID is caused by bacteria. Bacteria can move upward, from a woman's vagina or cervix (opening to the uterus, or womb) into her fallopian tubes, ovaries and uterus, causing infection. Many types of bacteria can cause PID. But, bacteria found in two common sexually transmitted diseases (STDs) - gonorrhea and chlamydia - are the most frequent causes of PID. After being infected, it can take from a few days to a few months to develop PID.

Although rare, a woman can develop PID without having an STD. No one is sure why this happens, but normal bacteria found in the vagina and on the cervix can cause PID.

Yes. Women who are more likely to develop PID include:

• Women who have had a sexually transmitted disease (STD), especially gonorrhea and chlamydia.

• Sexually active women under age 25.

The symptoms of PID can range from none to mild to severe. When PID is caused by chlamydia, a woman may have no symptoms at all, or mild symptoms. Chlamydia itself often causes no symptoms, especially in women. Even with no symptoms, PID can cause serious damage to a woman's fallopian tubes, uterus, and ovaries.

Symptoms of PID can include:

• Pain in the lower belly area.
• Fever.
• Unusual vaginal discharge that may have a foul odor.
• Painful sexual intercourse.
• Irregular menstrual bleeding.
• Pain during a pelvic exam.

There are no specific tests for PID. PID often is hard to diagnose because the symptoms can be mild. Many cases of PID are not diagnosed because the woman or her health care provider think mild symptoms are nothing or are caused by something other than PID. To diagnose PID, health care providers will perform physical exams, including a pelvic exam, check for fever, look for abnormal vaginal or cervical discharge, and test for gonorrhea and chlamydia.

If the health care provider wants more information, she or he may order other tests. A pelvic ultrasound may be done to view the pelvic area to see whether the fallopian tubes are enlarged or an infection is present. Sometimes a laparoscopy may be needed. This is a minor surgical procedure where a thin tube with a light at the end (laparoscope) is inserted into the lower abdomen. This allows the surgeon to view the internal pelvic organs and take specimens, or tissue samples, for laboratory studies if needed.

PID can be cured with antibiotics. But any damage that has already been done to a woman's pelvic organs (uterus, fallopian tubes, and ovaries) before treatment will not be reversed. Early treatment for PID is very important. The longer a woman waits to get treatment, the more likely she is to become infertile (not able to get pregnant). She is also putting herself at greater risk for having an ectopic pregnancy (pregnancy in the fallopian tubes that can be life threatening). A woman should see a health care provider right away if she thinks she has PID. In extreme cases, surgery is sometimes done for women with severe PID.

When a woman has PID, she can develop serious problems with her pelvic organs (fallopian tubes, uterus, and ovaries). And, damage done by PID to the pelvic organs can't be made better. Early treatment can help to prevent the serious problems that PID can cause. The more often a woman has PID, the more likely she is to develop problems.

With PID, bacteria infects the fallopian tubes (or tubes) or causes inflammation of the tubes. This causes normal tissue to turn into scar tissue. Tubes can become totally blocked with scar tissue, causing infertility (not being able to get pregnant). But, tubes do not have to be totally blocked to cause infertility - even a small amount of blockage or damage can keep a woman from getting pregnant. About 1 out of every 5 women with PID becomes infertile. The more often a woman has PID, the greater her chances are of not being able to get pregnant.

A tube that is partly blocked or damaged from scar tissue may cause a fertilized egg to get stuck in the tube. The egg can start to grow inside the tube, like it does when it is in the uterus, or womb. This is called an ectopic pregnancy, which is a pregnancy in the fallopian tube or elsewhere outside the uterus. As it grows, an ectopic pregnancy can cause the tube to rupture, or break open, and cause severe pain, internal bleeding, and even death.

PID can cause scar tissue to develop not only in the tubes but in other areas of a woman's abdomen. This can cause chronic pelvic pain (pain that last for months or even years). The more often a woman has PID, the more likely she is to become infertile, have an ectopic pregnancy, and develop chronic pelvic pain.

PID is most often caused by a sexually transmitted disease (STD) that has not been treated. You can protect yourself from PID by protecting yourself from getting an STD:

• The best way to prevent an STD is to practice abstinence (don't have sex). Delaying having sex for the first time is another way to reduce your chances of getting an STD. Studies show that the younger people are when having sex for the first time, the more likely it is that they will get an STD. The risk of getting an STD also becomes greater over time, as the number of a person's sex partners increases.

• Have a sexual relationship with one partner who doesn't have any STDs, where you are faithful to each other (meaning that you only have sex with each other and no one else).

• Practice "safer sex." This means protecting yourself with a condom EVERY time you have vaginal, anal, or oral sex.
  
  For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. If needed, use only water based lubricants with male and female condoms. For oral sex, use a dental dam - a device used by dentists, made out of a rubbery material, that you place over the opening to the vagina before having oral sex. If you don't have a dental dam, you can cut an unlubricated male condom open and place it over the opening to the vagina.
  
  Even though it may be embarrassing, if you don't know how to use a male or female condom, talk to your health care provider. The biggest reason condoms don't work is because they are not used correctly.

• Be aware that condoms don't provide complete protection against STDs. But, they do decrease your chances of getting an STD. Know also that other methods of birth control, like birth control pills, shots, implants, or diaphragms don't protect you from STDs. If you use one of these methods, be sure to also use a condom every time you have sex.

• Limit your number of sexual partners. Your risk of getting an STD increases with the number of partners you have.

• Don't douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This can increase your risk for getting an STD.

• Learn how to talk with your partner about STDs and using condoms. It's up to you to make sure you are protected. The organizations in the "For more information" at the end of this FAQ have tips for talking with your partner. You can also talk with your health care provider about this.

• When you are sexually active, especially if you have more than one partner, get regular exams for STDs from a health care provider. Tests for STDs can be done during an exam. And, the earlier an STD is found, the easier it is to treat.

• Learn the common symptoms of STDs. Seek medical help right away if you think you may have an STD.

Sometimes a person may be too scared or embarrassed to ask for information or help. But, keep in mind most STDs are easy to treat. Early treatment of STDs is important. The quicker you seek treatment, the less likely the STD will cause you severe harm. And the sooner you tell your sex partners about having an STD, the less likely they are to spread the disease to others (because they can get treated).

Doctors, local health departments, and STD and family planning clinics have information about STDs.