Sexually transmitted infections
Pelvic inflammatory disease (PID)
What is pelvic inflammatory disease?
Did you know?
Although PID affects women only, the bacteria responsible for
causing pelvic inflammatory disease can—and often does—infect
her partner also. In other words, if you have pelvic inflammatory
disease, your partner can be infected with the bacteria that
caused your PID. Be sure to tell your partner(s) you are infected
so they can be treated also. If your partner is infected too,
avoid sex until both of you have completed your treatment and
the doctor has determined the infection is gone. Otherwise,
if you have unprotected sex, your partner may re-infect you.
Although it refers to an infection of a woman's upper reproductive
organs (including the uterus, fallopian tubes, cervix and ovaries),
pelvic inflammatory disease (or PID) can also occur as a lower
abdominal infection. Pelvic inflammatory disease usually begins
at the vagina and cervix and spreads from there into the uterus
and fallopian tubes. Pelvic inflammatory disease can also occur
outside of the female reproductive organs, in the tissues surrounding
As its name suggests, pelvic inflammatory disease causes inflammation.
Inflamed tissues become swollen, hot, red and painful. The infection
and inflammation can damage tissues, leaving permanent scars.
It is the scarring that leads to the long-term complications of
PID—complications such as chronic pelvic pain, ectopic pregnancy,
What causes PID?
Because PID is caused by bacteria—some of which are also
known to cause other sexually transmitted
infections including chlamydia
and gonorrhea—your risk of developing
PID is increased if you are infected with another sexually transmitted
infection and don't seek treatment.
Although some types of PID are caused by the same bacteria that
cause other sexually transmitted infections,
a diagnosis of PID doesn't necessarily mean you have another STI.
The bacteria responsible for your PID may have spread from your
rectum or from a pad or tampon in place too long. Sexually transmitted
infections, however, remain the leading cause of PID.
Who gets PID?
Although PID can affect all women, you are at higher risk if:
- you're younger (18 to 24);
- you've had unprotected sex with an infected partner—usually
a person infected with either chlamydia
- you've had PID before (some studies suggest that up to 25
percent of PID cases recur)
- you've undergone pelvic surgery
- you developed complications during childbirth
- you have a new sex partner(s)
- you've had more than two sex partners in the past six months
Using an IUD (intrauterine
device) has been shown to increase the risk of developing
pelvic inflammatory disease (particularly if you have an infection),
while the use of oral contraceptives (the Pill) has been shown
to decrease the risk.
What are the signs and symptoms of PID?
Canadian statistics suggest that one in ten women will experience
at least one episode of PID. Women affected by pelvic inflammatory
disease often show no symptoms. Those who do experience symptoms
typically complain of pain or pressure in the lower stomach belly,
which they describe as constant and dull. Some women liken this
pain to the pain of a bladder infection, appendicitis, or menstrual
cramps. This pain may increase during bowel movements, sexual
activity, or while urinating. Occasionally, the pain caused by
PID may be so acute that it requires hospitalization.
Other symptoms may include:
- abnormal vaginal bleeding or discharge, sometime accompanied
- lower back pain
These symptoms often start at the end of a woman's menstrual
How is PID diagnosed?
As mentioned, a woman may have pelvic inflammatory disease and
not know it unless long-term consequences develop (see below).
If you have symptoms that may be linked to PID, you must be examined
by a doctor or nurse. He or she will check your abdomen for tenderness
and will also conduct a pelvic exam to check for pelvic tenderness.
Laboratory tests such as a urine test, cervical swab and vaginal
swab will be done to determine which specific bacteria caused
the infection. In some cases, a blood test may be useful to identify
PID: measuring a your white blood cell count can help determine
whether you have an infection.
How is PID treated?
Because early treatment is of the utmost important and because
delay in treatment can cause PID to become much more serious,
doctors usually start treatment right away.
Mild to moderate pelvic inflammatory disease is usually treated
through the prescription of antibiotics taken by mouth. In some
cases, however, PID can be severe enough that patients need to
be admitted to hospital in order to receive antibiotics intravenously.
Early treatment reduces the risk of serious, even life-threatening
What are the complications associated with PID?
Complications of PID may include:
- tubo-ovarian abscess (a swollen are full of pus inside an
ovary, the fallopian tubes or both) which can break and spread
the infection throughout the abdomen, resulting in:
- peritonitis, a condition that requires emergency surgery
- scarring of the pelvic organs including the ovaries, fallopian
tubes, bowel and bladder which can lead to:
- adhesions, a condition in which scar tissue joins two
organs, causing pain when a woman moves
- long-lasting, chronic, or permanent pelvic pain
- Increased risk of a pregnancy in which the fertilized
egg attaches to either the fallopian tube or to an area
outside the uterus
If prescribed antibiotics to treat pelvic inflammatory disease
and to prevent future PID, be sure to take all medication as directed
and to rest in bed for one to three days or until the pain is
lessened. Return to your doctor or clinic within two to four days,
again a week to ten days later, and then again for a follow-up
visit between six to eight weeks after completing treatment to
ensure the infection is completely cleared. Avoid sexual activity
until you have finished taking all of your medication.
Does PID require surgery?
Scar tissue can be removed surgically if it has joined two organs
together or if it is causing pain or other complications. During
surgery, the doctor will cut the adhesion, separating organs that
are joined together. Depending on the size and location of the
scar tissue, two surgical techniques may be used.
Laparoscopy uses a tiny camera mounted on a telescope. The laparoscope
is inserted through a tiny incision in a patient's belly button
and is used to guide the surgery. Small amounts of scar tissue
can be removed through the telescope. Done as a day procedure,
laparoscopic surgery is performed under general anesthetic. Women
undergoing laparoscopic surgery can expect three to five days
of abdominal pain.
The second option, a laparotomy, is open surgery usually reserved
for extensive adhesions or scar tissue. The procedure—major
surgery requiring general anesthetic—is performed through
an incision made in the abdominal wall. Women undergoing laparotomy
can expect a hospital stay of two to four days and a recovery
time of four to six weeks.