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Pelvic inflammatory disease (PID)

Pelvic inflammatory disease, or PID, is an infection of a woman's upper genital tract, including the ovaries, fallopian tubes and the womb.

PID can be caused by bacterial infections and sexually transmitted infections, and can cause infertility.

What causes pelvic inflammatory disease?

Normally, the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to a sexually transmitted infection - such as gonorrhoea or chlamydia - the cervix itself becomes infected and less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract. Untreated gonorrhoea and chlamydia cause about 90% of all cases of PID. Other causes include abortion, childbirth, and pelvic procedures.

What are the symptoms of pelvic inflammatory disease?

The symptoms of PID can vary, but may include the following:

  • Dull pain or tenderness in the stomach or lower abdominal area, or pain in the right upper abdomen.
  • Abnormal vaginal discharge that is yellow or green in colour or has an unusual odour.
  • Irregular or painful periods.
  • Painful urination.
  • Spotting or cramping throughout the month.
  • Chills or high temperature.
  • Nausea and vomiting.
  • Pain during sex.

What puts a woman at risk of pelvic inflammatory disease?

There are several things which put a woman at risk of PID, including:

  • Women with sexually transmitted infection - especially gonorrhoea and chlamydia - are at greater risk of developing PID.
  • Women who have had a prior episode of PID are at higher risk of another episode.
  • Sexually active teenagers are more likely to develop PID than are older women.
  • Women with many sexual partners are at greater risk of sexually transmitted infections (STIs) and PID.

Some studies suggest that douching may contribute to PID. Douching may push bacteria into the upper genital tract and may mask the discharge that could alert a woman to seek medical attention.

How is pelvic inflammatory disease diagnosed?

Your GP or sexual health clinic doctor will begin with a detailed history of your general health and sexual activity. They will perform a pelvic examination to check the health of your reproductive organs, and look for evidence of gonorrhoea and chlamydia infection. Your doctor may find abnormal cervical discharge and tenderness of the cervix and fallopian tubes on examination. This discharge will be tested to determine the cause of the infection, including cultures for gonorrhoea and chlamydia.

If your doctor suspects PID, he or she may arrange other tests, including:

  • Blood tests to analyse blood for evidence of infection.
  • Ultrasound (scan) to view the reproductive organs.

Other tests less commonly performed include:

  • Endometrial biopsy, a procedure in which a small sample of tissue from the lining of the uterus (endometrium) is removed for evaluation and testing
  • Laparoscopy, a procedure during which a thin, lighted instrument (laparoscope) is inserted through a small cut in the lower abdomen to allow the doctor to examine the internal reproductive organs
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