Pelvic inflammatory disease (PID) can negatively impact fertility, so it’s important for people trying to become pregnant to know the signs and symptoms. It’s equally important for those who are not looking to have children to have a good understanding of this serious disease, because it often has negative effects on one’s overall health if not treated.
According to the Cleveland Clinic, pelvic inflammatory disease is an infection that impacts the uterus, fallopian tubes and/or ovaries. Bacteria from untreated sexually transmitted infections (STIs) are the typical culprit, but bacteria normally found in the vagina can also cause PID.
The BC Centre for Disease Control says that because PID is not a reportable infection in Canada, it’s not clear exactly how common it is, but there are approximately 100,000 cases of symptomatic PID annually among Canadians. This means about 10-15% of folks with a uterus that are of reproductive age in our country have had an episode of PID.
Symptoms:
Signs that you have PID may be subtle or even unnoticeable at first. In fact, some people do not know they have PID until they struggle to get pregnant. The symptoms may come on suddenly, so it’s important to pay attention to any of the following:
- Pain and/or tenderness in your belly
- Abnormal vaginal discharge, typically yellow or green with an unusual odor
- Chills or fever
- Nausea and vomiting
- Pain during sex
- Burning during urination
- Irregular periods
Causes and Risk Factors:
Bacteria that lead to PID usually come from sexually transmitted infections like gonorrhea and chlamydia, but it’s possible for regular bacteria to make its way into the reproductive system whenever the cervix is disturbed, like during menstruation, childbirth, or an abortion.
The Mayo Clinic says that while it is much less common, bacteria can also enter the reproductive organs during an intrauterine device (IUD) insertion, or during a medical procedure involving instruments and the uterus.
There are certain lifestyle factors that can increase your risk of PID. These include having multiple sexual partners, having sex without barrier contraception such as a condom, and douching regularly. Douching (cleaning out the inside of the vagina with fluids) can upset the balance of good and harmful bacteria in the vagina. It can also mask symptoms of PID, and is not advisable.
Having a history of PID or other STIs increases your risk of having another infection.
Diagnosis:
The NHS says there is no single test that diagnoses PID. Rather, your doctor will ask about your medical and sexual history, and then perform a pelvic examination to check for tenderness and abnormal vaginal discharge. These tests can be uncomfortable for the patient, especially if they have PID.
Your doctor will usually swab the inside of your vagina and cervix and send the swabs to a laboratory to identify the bacteria and possible infection. Unfortunately, PID can be difficult to diagnose, and many swabs come back negative even when the patient has pelvic inflammatory disease.
Subsequent tests to diagnose or rule out other diagnoses include urine or blood tests, pregnancy tests, ultrasound scans, and occasionally laparoscopies.
Complications:
The longer PID is left untreated, the more serious its impacts. Pelvic inflammatory disease can lead to scar tissue of the fallopian tubes. This can cause the following problems:
- Chronic pelvic pain (the most common complication)
- Ectopic pregnancy: scarring can act as a barrier for fertilized eggs moving into the uterus, which can lead to the egg implanting inside the fallopian tube instead
- Infertility: up to 10% of people with PID lose their ability to become pregnant because of scarring
- Tubo-ovarian abscess (TOA): this is an infection in your pelvis that can cause extreme sickness
Treatment Options:
Oral antibiotics will be prescribed by your medical provider with a regimen that usually lasts 14 days. It’s important to continue the regimen until it is complete, even if you are feeling better. It’s also important to abstain from sex until you finish treatment and inform your partner of your diagnosis so they can get treatment.
If you continue to have symptoms after the antibiotic course is over, you may require IV medication at a hospital, especially if you are pregnant, feeling very sick, or have an abscess of the fallopian tube or ovary.
Surgery for PID is rare, but may be needed in some cases.
Prevention:
While PID can be caused by bacteria already found in the vagina, it is usually caused by an STI. You can lower your chances of getting PID by practicing protected sex with condoms or other barrier contraception that include a spermicide, even if you take birth control pills.
It’s important to seek treatment if you notice symptoms such as unusual vaginal discharge, pelvic pain or bleeding between periods. Although sometimes mild, these symptoms can escalate quickly.
While it can be uncomfortable both physically and mentally, regular gynecological check-ups are crucial, not just for PID, but for your overall health. Consistent visits and exams with your doctor make it more likely that they will be able to treat a cervical infection before it has a chance to spread to your reproductive organs.