What Causes Pelvic Inflammatory Disease?

Published on 12/17/20

Pelvic Inflammatory Disease or PID is an infection that affects the female reproductive organs. This happens when a sexually transmitted bacteria spreads from the vagina to the uterus, ovaries or fallopian tubes. 

Some women experience subtle symptoms and some mild symptoms. Whereas, some women don’t experience any signs or symptoms at all. This means that some women may not even realize they have pelvic inflammatory disease until she starts to experience chronic pelvic pain or have trouble getting pregnant. 

The type of bacteria that causes PID can be a multitude of bacteria but infections like gonorrhea or chlamydia are known to be the most common. These infections can happen during unprotected sex. 

Less common is bacteria that enters your reproductive tract when the normal barriers created by the cervix are not normal. This happens after childbirth, during menstruation, abortion or miscarriage. It is rare with devices like IUDs – a form of birth control – to allow bacteria to enter the reproductive tract during the insertion procedure or any medical procedure that involves insertion into the uterus. 

The Risks for PID

Factors that involve Pelvic Inflammatory Disease may increase a number of risks that could include:

  • Being a sexually active woman younger than 25 years old
  • Having multiple sexual partners
  • Being in a sexual relationship with a person who has more than one sex partner
  • Having sex without a condom
  • Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms
  • Having a history of pelvic inflammatory disease or a sexually transmitted infection

The increased risk of PID after the insertion of an intrauterine device is small. And if the risk exists, the time frame for the risk will be confined to the first three weeks after insertion. 

Pelvic inflammatory disease infects the organs of a woman’s reproductive system. The organs normally affected are the ovaries, fallopian tubes, uterus, and cervix. Normally as a result of a sexually transmitted infection or, STI like chlamydia or gonorrhea. Which can normally be treated with antibiotics. 

It’s possible to not notice any symptoms of PID during the early onset. However, as the infection gets worse you may find symptoms start to show that could be anything from:

  • Pain in your lower belly and pelvis
  • Heavy discharge from your vagina with an unpleasant odor
  • Bleeding between periods
  • Pain during sex
  • Fever and chills
  • Pain when you pee or a hard time going

For some cases of PID, intense symptoms can send you on a trip to the emergency room. If you notice any of these symptoms, get medical help right away:

  • Severe pain in your lower belly
  • Signs of shock, like fainting
  • Vomiting
  • Fever higher than 101 F

These symptoms can also be signs of other serious medical conditions like ectopic pregnancy (which is a pregnancy that happens in a fallopian tube outside the woub) or appendicitis. For these, medical attention is necessary. 

How does PID affect women?

PID can damage the reproductive system. This could mean damage to the ovaries, fallopian tubes, and uterus. PID can also make it difficult for a woman to get pregnant in the future. As well as be painful. PID also leads to tubo ovarian abscess (TOA) which is a pocket of infection in the pelvis and if left untreated, can make people very sick. 

Who’s at risk?

You’re at a higher risk for pelvic inflammatory disease if you:

  • Have a sexually transmitted infection (STIs), especially gonorrhea or chlamydia.
  • Have many sexual partners or have a partner who has had multiple partners.
  • Have had PID in the past.
  • Are sexually active and younger than 25.

Is PID Common?

More than 1 million women in the U.S. get PID and in that 1 million, more than 100,000 women deal with infertility because of it. In addition to infertility, there are many cases of ectopic pregnancies as a result of PID. If an ectopic pregnancy goes untreated, it needs immediate medical attention. 

In recent years, however, cases of PID have dropped. Most reasons may be due to regular testing for gonorrhea and chlamydia – which is the leading cause of PID – are now part of women’s yearly exams. 

What if PID goes untreated?

When bacteria enters the vagina, the cervix normally keeps it from spreading deeper to other reproductive organs but when the cervix becomes infected by an STI like gonorrhea and chlamydia, the cervix is compromised and less able to keep bacteria out. 

When the gonorrhea and chlamydia cause about 90% of the PID cases, the other 10% can be caused by:

  • Abortion.
  • Childbirth.
  • Pelvic procedures.
  • Insertion of an intrauterine device (IUD), either copper or hormonal. The risk is highest in the few weeks after insertion. Many times this type of infection is preventable with STI testing around the time of IUD placement.

PID is not always caused by an STI and some of the reasons may be unpreventable. Sometimes bacteria in your vagina can travel up to your reproductive organs and cause PID.

Avoid PIDs with a few tips:

  • Do not douche
  • Stay Abstinent 

If you decide to have sex. Here are a few tips to consider to help avoid getting a pelvic inflammatory disease:

  • Condoms Condoms are the best way to prevent STIs when you have sex. Make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
  • Testing. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
  • Limit Sexual Partners Your risk of getting STIs goes up with the number of partners you have.
  • Avoid Risky Behavior. Too much alcohol or using drugs increases risky behavior and may put you at risk of possible exposure to STIs.

These steps alone can’t protect you from every STI but work best when combined together for preventative measure. 

How Is PID Diagnosed?

In order to diagnose PID, doctors normally do a physical exam and test for specific STIs. 

If you think you may have PID, call and talk to your doctor as soon as possible. 

If you describe pain in your lower abdomen, your healthcare provider will check for:

  • Unusual discharge from your vagina or cervix
  • An abscess (collection of pus) near your ovaries or fallopian tubes
  • Tenderness or pain in your reproductive organs

There are tests to find out whether you have PID or a possible other conditions that may be similar to PID and include the same symptoms:

  • Tests for STIs, especially gonorrhea and chlamydia. These infections can cause PID.
  • A test for a urinary tract infection or other conditions that can cause pelvic pain
  • Ultrasound or another imaging test so your doctor can look at your internal organs for signs of PID

However, a Pap Test cannot be used to detect PID. 

Although women in the U.S. have only a 5% chance of infection, you may be at a higher risk if you:

  • Have had an STI
  • Have had PID before
  • Are younger than 25 and have sex. PID is most common in women 15 to 24 years old.
  • Have more than one sex partner or have a partner who has multiple sexual partners
  • Douche. Douching can push bacteria into the reproductive organs and cause PID. Douching can also hide the signs of PID.
  • Recently had an intrauterine device (IUD) inserted. The risk of PID is higher for the first few weeks only after insertion of an IUD, but PID is rare after that. Getting tested for STIs before the IUD is inserted lowers your risk for PID.

They might also recommend tests like:

  • Blood Test. This is to check for sexually transmitted infection.
  • Ultrasound. This will make a picture of your internal organs.

If your exam or tests come back with a high probability for PID, your doctor will discuss a plan with you for treatment in order to get rid of it. If your tests or exam come back 100% positive for PID, make sure to talk about your diagnosis with anyone you had sex with in the 60 days before your exam. This gives them enough time to get tested as well. 

In what ways is PID treated?

PID is treated with antibiotics. Mostly prescribed with at least two different antibiotics. Used to work against many different types of bacteria. The prescription must be taken entirely, even if your symptoms seem to go away.  This will help make sure the infection is fully cured. 

Schedule an appointment to see your doctor or nurse again in two to three days after starting the antibiotics. This way you can ensure you are working properly. 

Your healthcare provider may suggest a hospital visit to treat your PID if you display symptoms such as:

  • You are very sick
  • You are pregnant
  • Your symptoms do not go away after taking the antibiotics or if you cannot swallow pills. If this is the case, you will need IV antibiotics.
  • You have an abscess in a fallopian tube or ovary

If you still display symptoms or if you develop an abscess that does not go away after treatment, surgery may be an option. There are problems caused by PID that are often hard to treat but can get better with surgery. 

Problems such as:

  • Chronic pelvic pain
  • Scarring

Can you still get pregnant if I had a PID?

It’s still possible. The chances of getting pregnant tend to be lower if you have had a PID more than once. Once the bacteria gets into the fallopian tubes it can cause inflammation. This can cause scarring in the tissue that makes up your fallopian tubes which can make getting pregnant difficult. 

The scar tissue can hinder an egg from entering or traveling throughout the fallopian tube to your womb. That same scar tissue can make the sperm attachment to the egg difficult for pregnancy to happen and pregnancy may be hard without fertility treatment. 

In addition to scar tissue and fertility, even during pregnancy, scar tissue from PID can cause ectopic pregnancy instead of a normal pregnancy. Ectopic pregnancies are more than six times more likely in women who have had PID compared to women who have never had PID. Unfortunately, most of these pregnancies end in miscarriage. 

For More On Pelvic Inflammatory Disease, Call Rosh Maternal & Fetal Medicine in NYC

Some of the conditions that cause pelvic pain can lead to complications like infertility, so it’s important to consult the doctors at Rosh Maternal & Fetal Medicine. If you have any type of pelvic pain, call their office in the Midtown East area of New York City, or schedule an appointment online so they can determine the underlying cause and treat the problem.

You shouldn’t have to live in silence with pelvic pain. Talk to our team by phone or book an appointment online to get started finding relief. Call one of our six convenient NYC locations or schedule a video consultation online today. Women with pelvic pain and inflammation can count on the experienced and compassionate care of the team at Rosh Maternal & Fetal Medicine in NYC. They’ve helped thousands of women. Come visit your NYC OBGYN.