Pelvic Inflammatory Disease

About one million American women have pelvic inflammatory disease (PID). It is an infection that goes up through the uterus to the fallopian tubes. One or more types of bacteria and/or other parasites are the culprits. These organisms can be carried by both women and men. They can be passed on to someone else who could then develop PID even when no symptoms are noticeable. When symptoms are present, they can vary from woman to woman. PID can be acute or chronic.

Symptoms of Acute PID:

• Pain in the abdomen or back (can be severe).
  
• Bad smelling vaginal discharge.
  
• Pain during intercourse.
  
• Abdominal tenderness and/or bloating.
  
• Difficult menstrual cramps.
  
• High fever.
  
• Symptoms of Chronic PID:
  
• Pain (less severe) – often occurs halfway through the menstrual cycle or during a pelvic exam.
  
• Skin on abdomen is sensitive.
  
• Vaginal discharge.
  
• Change in menstrual flow.
  
• Nausea.
  
• Low grade fever.

The Causes of PID:

• A sexually transmitted disease (STD) such as gonorrhea and chlamydia. The organisms that cause these STDs travel into the internal reproductive organs.
  
• Bacteria normally found in the intestines that get into the pelvic cavity. This most likely happens:
  
  • After sexual intercourse, especially having vaginal intercourse right after having anal intercourse.
    
  • After getting an intrauterine device (IUD) put in or repositioned (low risk).
    
  • Because of high risk sexual practices that increase the risk of infection, such as having multiple sex partners or having sex with a person who has many partners.
    
  • Having had PID in the past or a recent bout with vaginitis.

The symptoms of PID are a lot like those of other conditions such as endometriosis (see page 21) and urinary tract infections (see page 54). This can make it hard to diagnose from symptoms alone. To know whether or not you have PID, your doctor may need to do a laparoscopy (a scope is inserted into the abdomen through a small incision(s) so the surgeon can see inside to find the cause). An ultrasound may also be done.

Treatment

Treatment for PID is antibiotics (often more than one kind over a period of three to four weeks) and bed rest. If the infection is severe, intravenous (IV) antibiotics may need to be given in a hospital. Preventing further infections is important. This may include treatment for an infected sex partner so as not to get re-infected.
When PID is not treated, it can lead to blood poisoning, blood clots that break off and travel to the lungs and bands of scar tissue in the pelvis. All of these can be life threatening.

Permanent damage to a woman’s reproductive organs and/or infertility can occur as well. Also, a woman who has had PID is at increased risk for:

• Ectopic or tubal pregnancy.
  
• Premature labor and birth.

Questions to Ask

Do you have two or more of the following? Pain in the abdomen or back (this may be severe). Bad smelling vaginal discharge. Pain during intercourse. Abdominal tenderness and/or bloating. Difficult menstrual cramps. High fever.
Do you have two or more of these? Pain in the abdomen or back halfway through your menstrual cycle. Skin on your abdomen feels sensitive. Vaginal discharge when you’re not having a menstrual period. Change in menstrual flow. Low grade fever.
Have you had an IUD inserted, especially within the last 20 days, and are you feeling discomfort from it?
Have you had unprotected sex with someone who has PID or do you think might have a sexually transmitted disease? (Unprotected sex means without the use of a male or female condom with spermicide).

Self-Care/Preventive Procedures

• Wipe from front to back after a bowel movement to keep bacteria from the feces from entering the vagina.
  
• Change tampons and/or pads frequently when you menstruate.
  
• Don’t have vaginal intercourse right after anal intercourse.
  
• Don’t have sex with anyone who has not been treated for a current case of PID or STD or anyone who has partners that haven’t been treated.
  
• Use barrier birth control methods with spermicides to reduce the risk of getting PID from an infected partner. These include the male or female condom, cervical cap or diaphragm. Use these even if you use other contraceptives like the pill.
  
• If you use an IUD, have your doctor remove it if you become pregnant and then miscarry. If it is left in, your risk for PID goes up.
  
• Don’t smoke. If you smoke 10 or more cigarettes a day, you have a higher risk for PID.
  
• Don’t douche. This may spread the organisms that cause infection and in so doing, increase the risk for PID.
  
• Do not have sexual intercourse for six weeks after childbirth or for one week after a D & C, abortion or miscarriage. Use a condom for 2 weeks after having an IUD inserted.
  
• Get tested for chlamydia and gonorrhea every 6 months if you are at risk for PID. (See causes of PID on page 50).