What is pelvic inflammatory disease?
This is an inflammation affecting the organs in the pelvis. This
is usually caused by an infection that spreads from the vagina
through the cervix (the entrance to the womb) to the uterus (womb)
and then up higher through the fallopian tubes (these tubes carry
eggs from the ovaries to the womb) towards the ovaries and then to
the inside of the abdomen.
If this inflammation occurs suddenly and is severe it is called
'acute PID'. It can also cause a collection of fluid to develop,
usually inside the tubes and close to the ovaries (this is called a
tubo-ovarian abscess and is a serious complication that will
require hospital treatment).
Sometimes the inflammation is less severe and can persist for a
long time - this called chronic PID.
Who gets PID?
Women get PID because this is an inflammatory process affecting
female organs inside the pelvis. PID is common and tends to affect
younger women (under the age of 45). Those under the age of 25 are
most at risk. These women are usually sexually active and may
have acquired an infection such as gonorrhoea or chlamydia from a
sexual partner without realising.
What causes PID?
The most likely cause of PID is untreated Chlamydia or
gonorrhoea. These two sexually transmitted infections cause
one quarter of cases of PID, and may be passed from a sexual
partner without realising as they often do not cause symptoms.
Is PID always sexually transmitted?
No. Sometimes PID is caused by infections that are not sexually
transmitted. It can occur after fitting a coil. Occasionally,
PID can develop after a miscarriage or an abortion. Rarely, it can
occur after surgery to pelvic and abdominal organs such as the
bowel and even after appendicitis.
How will I know if I have PID?
Each person with PID is different, symptoms vary. The following
list of symptoms may all be present in some people but others may
only have some of them:
- Smelly or unusual vaginal discharge
- Pain in the lower abdomen
- Deep pain inside during sexual intercourse
- Bleeding during or after sex
- Bleeding between periods
- A high temperature
These symptoms in themselves are not uncommon and can be caused
by other conditions. PID can be difficult to diagnose because your
doctor is also thinking about other possible explanations for each
of the symptoms listed above.
If you have lower abdominal pain, this can be due to irritable
bowel syndrome (IBS), a urine infection (cystitis), a cyst on the
ovary, appendicitis or even inflammatory bowel disease such as
ulcerative colitis or Crohn's disease. Pregnancy is a very
important cause of abdominal pain especially if the pregnancy is
developing in the wrong place such as one of the tubes
(ectopic). Scarring after PID can lead to ectopic
Bleeding between periods can be caused by hormonal contraception
such as the pill, an implant, the depo injection or a hormone coil
Smelly discharge can be due to a condition called bacterial
How do I get tested for PID?
Your doctor will need to examine you if he or she suspects that
you might have PID. The diagnosis can be difficult to make but
needs to take account of information that you give the doctor about
your symptoms, personal medical history and sexual history
including any new sexual partners in the recent past. Sometimes,
the examination can cause a little discomfort.
Your doctor will recommend that you have a number of swab tests
from the vagina and the cervix. The swab tests are to look for
Chlamydia or gonorrhoea, as these are important causes of PID. One
of the swab tests is used to look for inflammation at the cervix.
In a specialist sexual health clinic like the Sandyford this test
is done whilst you wait. They will also look for other types of
infection often present in the vagina.
You will be offered a pregnancy test to make sure you are not
Your urine will be tested to see if there are any signs of
infection that may indicate cystitis.
Blood tests are used to help make a diagnosis as a raised level
of white blood cells indicates infection.
You will be offered the opportunity to have an HIV and syphilis
test so that your check-up is complete for all the sexually
transmissible infections. This is very important as PID can be a
sign of an immune system that is not functioning well.
Occasionally, further tests may be needed such as an ultrasound
scan or a laparoscopy ( a small operation under anaesthetic where a
small telescope is passed through the belly button to look inside
the abdomen - this is important if the diagnosis is not
What treatments are available if I have
If your PID is thought to be, mild or moderate (but not severe),
you will be offered a course of antibiotic tablets. These
antibiotics are chosen specifically to fight the most likely
organisms thought to be causing your PID. This course of
antibiotics will normally last for two weeks. It is very important
to complete the entire course even if you are feeling better. Most
women completing their treatment will have no long term health or
fertility problems. It is important that you tell the doctor if you
are taking any other medicines including the contraceptive pill. If
you think you might be pregnant, tell the doctor or nurse as
certain antibiotics should be avoided in pregnancy. It is also rare
to develop PID if you are pregnant. If you have a coil in place,
your doctor will talk to you about whether this should stay in or
Will I need to stay in hospital for
Staying in hospital for treatment is recommended if:
- The diagnosis is not certain
- You are very unwell
- An abscess is thought to have developed
- You are pregnant
- You are not getting better despite having started
- Or you are not managing to take your tablets
Sometimes the antibiotics are given by an intravenous drip until
you show signs of improvement. Sometimes an operation might be
needed if an abscess is found as this will need draining, usually
via a laparoscopy.
What should I tell my partner?
It is usually recommended that, if your PID is thought to have
occurred because of a sexually transmitted infection, your
partner(s) see a specialist sexual health clinic for a sexual
check-up and get precautionary treatment. You will be asked not to
have sex with your partner(s) until they have been tested and
treated. Our health advisors will talk to you about the best ways
to contact and inform current and past partners. They can assist
you with this and do it for you, if you agree, without disclosing
any information about you.
When can I have sex again?
You should avoid having sex again with anyone who might have an
untreated infection. If this is not possible, then condoms will
help reduce the chance of catching infections. If your partner has
been tested and treated, you can have sex again when you feel
Will I need to have a follow-up
You will usually be given a further appointment to see a doctor
to make sure that the antibiotics have worked.
Are there any long-term problems after PID?
Pelvic inflammation and infection responds very well to
antibiotics. Most women make a full recovery without any further
problems. If the infection was very severe, or treatment delayed
for some reason, then it is possible to get further problems such
- Scarring of the Fallopian tubes which can cause an increased
risk of ectopic pregnancy or difficulties in getting pregnant.
- Long term pain that persists even after treatment
These problems are more likely if you get repeated episodes of
pelvic pain. The use of condoms will help reduce the risk of