This factsheet is for women who have pelvic inflammatory disease (PID), or who would like information about it.
PID is an infection of the female reproductive organs, usually caused by a sexually transmitted infection (STI). Although PID can often be treated quickly and effectively, if left untreated, it can cause infertility.
About PID
PID is a common health problem – in England and Wales, it's the reason for one in 60 visits to a GP by women under 45.
PID is usually caused by an infection that starts in your vagina and cervix (neck of your womb) and spreads to your womb (uterus), ovaries and fallopian tubes (the tubes that go from your ovaries to your womb).
PID can become a chronic condition and pain in your pelvis can persist. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person's life. When describing an illness, the term 'chronic' refers to how long a person has it, not to how serious a condition is.
PID can affect your quality of life and also your ability to have children.
Symptoms of PID
Most women with PID have no symptoms. If you do have symptoms, they may include:
- an abnormal vaginal discharge that may be smelly
- irregular periods, bleeding between periods or having heavier periods than usual
- pain in the lower part of your abdomen (tummy), which may spread to your legs
- uncomfortable or painful sex
- pain when you pass urine
- a high temperature (over 38°C)
- feeling sick or vomiting
These symptoms aren't always caused by PID but if you have them, see your GP or visit your local sexual health clinic. It's very important to seek help early to reduce your chances of developing complications.
Complications of PID
There are a number of possible complications of PID. These include the following.
- PID can cause infertility – the risk of you becoming infertile after having PID is related to the number of times you get the disease and how severe it is.
- For those women with PID who do go on to get pregnant, they are more likely to have an ectopic pregnancy than women who have never had PID. Ectopic pregnancy is when a fertilised egg implants outside the womb, most often in one of the fallopian tubes. It's not possible for pregnancy to continue outside the womb.
- Chronic pelvic pain can develop after having PID.
Causes of PID
PID is most commonly caused by an STI, usually chlamydia or gonorrhoea. You can catch an STI by having sex with an infected partner – your partner may not know that he or she has an infection. Young women who have a new sexual partner, have had numerous sexual partners or have had unprotected sex are more at risk of STIs. Although women in same sex relationships are less at risk of STIs, it's still possible for these conditions to be passed on through oral sex or by sharing sex toys.
Rarely infections other than STIs can cause PID. Bacteria that are usually found in your vagina and on your cervix can sometimes get into your womb and spread to your fallopian tubes, ovaries and surrounding tissues. Although the bacteria are harmless to your vagina, they can cause an infection in other parts of your body.
You're also more likely to develop PID:
- in the first six weeks after having an intrauterine device (IUD) or coil inserted
- after having an operation, such as a termination of a pregnancy
- after giving birth
- if you douch your vagina (rinse out your vagina), although the evidence isn't certain
Diagnosis of PID
Your GP will ask about your symptoms and your medical history. He or she will also examine you.
Your GP may take some specimens from inside your vagina and cervix to test for bacteria. It's a simple procedure. Your GP will first insert a speculum into your vagina to hold it open, similar to when you have a smear test. He or she will take a cotton wool swab. The swabs will be sent to a laboratory to be tested for chlamydia and gonorrhoea. You will also be offered routine tests for other STIs.
If there is a possibility you could be pregnant, your GP may recommend that you have a pregnancy test because the symptoms of PID can be very similar to those of ectopic pregnancy. He or she may also test a sample of your urine to check for a urinary tract infection.
Your doctor may refer you to a specialist for further tests including:
- a pelvic ultrasound or transvaginal ultrasound scan, which use sound waves to produce an image of the inside of your body
- an MRI (magnetic resonance imaging) scan, which uses magnets and radiowaves to produce images of the inside of your body
- a CT (computerised tomography) scan, which uses X-rays to make a three-dimensional image of your body
- a biopsy, which involves taking a small sample of tissue from the lining of your womb, which will be sent to a laboratory for testing
- a laparoscopy, which is a procedure used to examine the fallopian tubes, ovaries and womb
Treatment of PID
Medicines
If your GP suspects that you have PID, he or she will prescribe antibiotics for you to start taking straight away, even though the test results probably won't be ready for a few days. This is because the long-term effects of PID can be serious, so it's best to start treatment as soon as possible.
Your GP will usually prescribe a two-week course of antibiotics to treat the infection. Always ask your GP for advice and read the patient information leaflet that comes with your medicine. It’s important to finish your treatment before you have sex again. If you have an IUD in place, your GP may recommend that you have it removed if your condition doesn't improve with antibiotic treatment.
Your GP will usually speak to you over the phone or ask to come back a few days later to see if your symptoms are getting better and to talk through your test results. He or she may then want to see you two to four weeks later to see if your treatment has been successful.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
If your symptoms are severe or you're pregnant, you may be admitted to hospital for further treatment. You will receive antibiotics through a drip for the first 24 hours, followed by tablets.
Surgery
The bacteria that cause PID can leave scar tissue and abscesses (collections of infected fluid) on the lining of your fallopian tubes. Surgery can reduce the risk of damage to the fallopian tubes and your other reproductive organs. A laparoscopy procedure may be used to repair blocked or damaged tubes by removing the abnormal tissue on the lining of your fallopian tubes and draining any abscesses.
Sexual partners
If you have a regular sexual partner, it’s important for him or her to make an appointment to see a GP for tests and treatment. Wait until you have both completed your treatment before you have sex to prevent you reinfecting each other.
Your GP may ask for details of your sexual history during the past six months or more. This will be in complete confidence. If you visit a sexual health clinic, staff there can contact your past partners for you.
Prevention of PID
The best way to reduce the risk of STIs that often cause PID is to use a barrier method of contraception. Condoms reduce your risk of getting an STI, but they can't completely prevent all infections.
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