PID: A Leading Cause of Infertility (2024)

Pelvic inflammatory disease (PID) is an inflammatory infection that affects the uterus, ovaries, and fallopian tubes. It is usually caused by the spread of a vaginal or cervical infection. Having an untreated sexually transmitted infection (STI) is one of the most common risk factors.

PID symptoms aren't always noticeable but can include vaginal discharge or pelvic discomfort. In some cases, it can lead to infertility or a fertilized egg implanting outside of the uterus (ectopic pregnancy).

This article reviews the symptoms, causes, diagnosis, treatment, and potential complications of pelvic inflammatory disease.

PID Symptoms

Symptoms of PID can include:

• Aching or pain in the lower abdomen and pelvis
• Fever
• Unusual vaginal discharge with a foul odor
• Pain and/or bleeding during or shortly after sex
• Discomfort during urination
• Bleeding between periods
• Nausea and vomiting

PID can go undetected for years because symptoms are not always present and are often mild or nonspecific if they do occur. Many people do not seek medical attention until health or reproductive complications occur.

If you do recognize any signs of pelvic inflammatory disease, seek medical attention as soon as possible.

What Causes Pelvic Inflammatory Disease?

PID can happen as a consequence of STIs, bacterial vaginosis (BV), or as a complication of pelvic surgery or gynecologic procedures. Chlamydia and gonorrhea are the most common infections associated with PID.

Risk factors for developing PID include:

• Unprotected sex: Having multiple sexual partners increases the risk of vaginal and cervical infections, particularly if barrier methods of protection are not used every time.
• Untreated vaginal or cervical infections: Lingering infections can allow the spread of an infectious organism from the vagina up to the uterus, fallopian tubes, or ovaries.
• Younger age: People in their teens or early 20s who are sexually active are more prone to PID than those over age 25.
• Douching: Research shows people who douche frequently have an increased risk of PID. Experts warn this may be because it alters the protective flora (normal bacteria) and pH of the reproductive tract, which may allow infections to thrive.
• Intrauterine devices (IUDs): There is an increased risk of PID within the first few weeks after IUD insertion.

Complications

Acute complications include the development of a pelvic abscess (enclosed infection) or a major pelvic infection. Symptoms of this may include fever, chills, nausea, vomiting, or severe pelvic pain.

In some cases, it can lead to lead to sepsis, a severe infection affecting the bloodstream, which is a potentially life-threatening response to an infection.

Longstanding untreated PID can result in serious health effects that affect reproductive health:

• Infertility: An infection can spread within the reproductive system, causing inflammation and scarring. This can narrow or block the fallopian tube, preventing sperm from reaching the egg for fertilization.
• Difficulty carrying a fetus to term: If a person is able to get pregnant, the scarring and inflammation may threaten the pregnancy by increasing the risk of premature birth.
• Ectopic pregnancy: If fertilization occurs in the fallopian tube, as it should, the narrowing due to PID may trap the egg there. This prevents it from reaching the uterus, where it needs to attach and grow for the remainder of pregnancy. This nonviable pregnancy causes severe abdominal pain and can become a life-threatening medical emergency.
  

Diagnosis

The diagnosis of PID generally involves a medical history, gynecologic exam, and swabs of the cervix to check for infections. Other tests like blood tests or pelvic ultrasound may also be done. Often, because there are no symptoms or few symptoms, diagnosis is made at a late stage when scarring has already occurred.

If you have PID, your healthcare provider will also do tests to identify the infectious organism.

Pelvic Examination

Several tests are used in the evaluation of PID. The first is a gynecologic (pelvic) examination. Your healthcare provider examines your vagina and cervix, using a speculum and light to see the area better.

You may have a Pap smear during this exam if you are due for one. The sample of cells taken from your cervix will then be sent to a laboratory so they can be viewed under a microscope. This test is used for cervical cancer screening only and is not used in making a diagnosis of PID.

A fluid sample may also be taken and sent to a lab for testing to identify the bacteria present.

Diagnostic Tests

Specialized diagnostic tests can help your healthcare provider visualize the structure of your reproductive organs and identify any areas of scarring throughout your reproductive tract.

• Transvaginal ultrasound: This involves the insertion of a camera into the vaginal opening. It can identify areas of inflammation or an abscess.
• Laparoscopy: This is a more invasive examination in which a camera is surgically inserted to identify structural changes, such as inflammation or scarring inside the reproductive tract and/or abdominal cavity.

PID Treatment

Pelvic inflammatory disease can be treated and cured when diagnosed early. Antibiotics and surgery are two possible treatment options.

Antibiotics

Oral (by mouth) antibiotics can be used to treat STIs and bacterial vaginitis before PID develops. If PID is detected, antibiotics can be used to target the infection. Typically the antibiotic is selected to provide broad-spectrum coverage of the likely bacteria responsible for the infection.

If you have an STI, your partner will need to be treated as well so that the infection will not continue to be transmitted back and forth.

Surgery

Inflammation and scarring can cause infertility and the risk of ectopic pregnancy. Sometimes scars can be surgically treated, but this can increase the risk of adhesions—scars that can cause even further problems.

An abscess may also require surgical removal, which is typically followed by oral or intravenous (IV, directly in the vein) antibiotics to ensure the infection clears.

Additional Treatment for Complications

Treating PID won't undo damage it has already caused. And the longer it is allowed to persist, the more likely there will be complications that also need treatment.

For example, sepsis requires immediate treatment with IV antibiotics.

When an ectopic pregnancy does not resolve on its own, or a fever or signs of an emergency develop, medication may be given to stop the pregnancy.

In some cases, the fertilized egg must be surgically removed to prevent life-threatening problems. This may require the removal of one of the ovaries or fallopian tubes.

Summary

PID is an inflammatory infection most commonly caused by sexually transmitted infections that can affect the uterus, ovaries, and fallopian tubes. Symptoms may be mild or not always noticeable. PID is treatable, especially if diagnosed early. When untreated PID can lead to ectopic pregnancy, sepsis, or infertility.

Talk with a healthcare provider if you suspect you have a sexually transmitted infection or any symptoms that could be related to PID.