Tell Me About...Pelvic Inflammatory Disease

By Adrienne Ton, NP

When people are taught about sexual health in schools (if they do discuss this at all), they often talk about “the clap” (gonorrhea) or “the clam” (chlamydia) and about how this can lead to acute symptoms like abnormal discharge from the urethra or the vagina, or maybe an odd rash or lesion. 

People often talk about symptoms that you can see, but often people aren’t taught about some of the less frequently discussed diseases that happen internally, like with Pelvic Inflammatory Disease. 

Pelvic Inflammatory (or PID) is a disease that affects a female’s upper genital tract. It is common in young, sexually active females - but this can happen at any age. 

Because the symptoms can vary from mild to more severe symptoms and because you can’t always see something wrong, this can sometimes be difficult to diagnose.

However, this is very important to treat as this can cause problems with chronic pelvic pain and/or infertility if left unaddressed. The good news is that we have some excellent tools to help prevent complications from this - like sexually transmitted infection screening and antibiotic treatments. 

What is PID?

Pelvic Inflammatory Disease (PID) describes a group of inflammatory disorders of the upper genital tract. PID is an acute infection that involves the upper genital female organs. This can include different structures such as endometritis (inflammation of the lining of the uterus), salpingitis (inflammation of the fallopian tubes), tubo-ovarian abscess (an sac of pus on the fallopian tubes/ovaries), and peritonitis (inflammation of the lining of the abdominal cavity). 

What causes PID?  

This is often called an “ascending” infection because it usually starts with an infection that starts in the vagina and cervix and travels up to the inside of the uterus and into the fallopian tubes. Rarely, this can be caused by an infection from the other adjacent organs, such as the appendix or intestines (such as in diverticulitis). 

PID can be caused by infection by multiple organisms. However, it is most often caused by sexually transmitted infections, such as gonorrhea and chlamydia. Sometimes, other infections that are normally in the vagina can have overgrowth and cause PID. We are also starting to see that Mycoplasma Genitalium is also a cause of PID, but this is an infection that is not regularly screened for. 

Once the infection spreads to those upper genital organs like the uterus and fallopian tubes, this can lead to pain, scarring of some of the structures, and permanent damage. 

What are the symptoms of PID? 

The symptoms of PID can vary from mild to severe, making it difficult to diagnose at times. 

Some people may not notice their symptoms. In mild cases, people may notice abnormal bleeding, pain during sex, and abnormal vaginal discharge. 

In more severe cases, people may also notice severe lower abdominal pain and fever. Sometimes people will experience nausea and vomiting as well.    

If you are being examined by a medical professional, people may have specific tenderness when an examiner palpates (meaning examines with their hands) areas such as your uterus, cervix, or adnexa (area next to your uterus). 

What are the long-term consequences of PID? 

Untreated pelvic inflammatory disease can lead to some serious long-term consequences.

PID increases the risk of fertility, or difficulty with conceiving. While this may not be important to you now (or ever), we recommend getting evaluated and treated for PID if you have this to help you keep your fertility options open in the future. 

PID also caused increased risk for ectopic pregnancies and chronic pelvic pain, often due to the damage and scarring to some of the upper genital structures.  Even mild PID can lead to problems with fertility. 

Is there treatment? 

Yes, treatment usually involves a course of multiple antibiotics that target a wide variety of organisms that cause this infection. Depending on how severe the symptoms are, this may require treatment with an antibiotic injection (such as through a vein or through a muscle) and some oral antibiotics. This allows for a stronger and more immediate response to the infection. 

How Can I Prevent This? 

  1. STI Prevention: Get screened for STIs! We can’t stress this enough. PID can be preventable if you’re able to help protect yourself from STI’s and/or get early treatment. Use barrier methods (like condoms), ask your partners to get tested, and get tested at least annually if you’re sexually active and/or have more than one partner. At least get screened for Gonorrhea and chlamydia as these are the most common causes of this disease.
  2. Get medically evaluated if you’re having symptoms. Noticing pain with sex, lower abdominal pain, weird vaginal discharge that is different from your normal? Get seen by a trusted medical professional! 

Remember - not everyone will have this disease but it’s an important diagnosis to consider, regardless of whether you want pregnancy in the future or not.

This article provides information about sexual health, healthcare and/or related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of TBD HEALTH INC.

Photo by Sasun Bughdaryan on Unsplash