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Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, including the uterus, fallopian tubes and ovaries. The infection usually starts in the vagina or cervix before spreading into the pelvis. Prompt treatment is important because untreated PID can lead to long-term complications, including fertility problems.

Commonality

PID occurs most frequently in sexually active women aged 15–25.

Causes

PID is usually caused by bacteria spreading from the vagina or cervix into the upper reproductive tract.


The most common causes are sexually transmitted infections (STIs) including:

  • Chlamydia

  • Gonorrhoea


Other bacteria can also contribute to PID, including organisms associated with:

  • Bacterial vaginosis

  • Mycoplasma genitalium


Less commonly, infection may occur following:

  • Childbirth

  • Miscarriage or abortion

  • Pelvic procedures such as intrauterine device (IUD) insertion


Risk factors include:

  • Multiple sexual partners

  • Unprotected sex

  • Previous sexually transmitted infections

  • Age under 25

  • Recent pelvic surgery or procedures

  • Recent childbirth or miscarriage

Symptoms

Symptoms can range from mild to severe, and some women may have very few symptoms.


Common symptoms include:

  • Lower abdominal or pelvic pain

  • Unusual vaginal discharge, often with an unpleasant odour

  • Pain during intercourse

  • Pain when passing urine

  • Bleeding between periods

  • Bleeding after sex

  • Heavy or painful periods

  • Fever

  • Feeling generally unwell


Because symptoms may be mild, PID can sometimes go undiagnosed until complications develop.

Effects on Fertility

PID can affect fertility by causing scarring or blockage of the fallopian tubes.


This may:

  • Prevent fertilisation

  • Increase the risk of ectopic pregnancy

  • Lead to infertility


Research suggests that 10–50% of women with previous PID may experience fertility problems, particularly when treatment is delayed. Early treatment significantly reduces these risks.

Diagnosis

There is no single test that confirms PID. Diagnosis is usually based on symptoms, examination findings and investigations.


Assessment may include:

  • Detailed medical and sexual health history

  • Pelvic examination

  • Vaginal and cervical swabs to test for infections such as chlamydia and gonorrhoea

  • Pelvic ultrasound to detect tubal inflammation, fluid in the fallopian tubes (hydrosalpinx) or pelvic abscess

  • Blood tests to assess infection and inflammation

  • Laparoscopy (keyhole surgery) in rare or complex cases

Treatments

Treatment should begin as soon as PID is suspected, often before test results are available.


Treatment may include:

  • Oral antibiotics for mild infection

  • Intravenous antibiotics for more severe infection

  • Treatment of sexual partners to prevent reinfection

  • Anti-inflammatory pain relief


Patients are usually advised to:

  • Complete the full course of antibiotics

  • Avoid sexual activity until treatment is complete

  • Attend follow-up appointments to ensure the infection has resolved


If complications develop, surgical treatment may be required, including:

  • Laparoscopic surgery

  • Robotic-assisted surgery in complex cases


Where possible, treatment aims to preserve fertility and minimise long-term pelvic damage.

Ongoing Care

Living with the Condition

PID can be concerning because symptoms may affect daily life and, in some cases, lead to long-term complications. Some women experience chronic pelvic pain or worry about future fertility following an episode of PID.


The good news is that early diagnosis and prompt treatment with antibiotics can significantly reduce the risk of long-term problems. Ongoing follow-up and specialist care can help protect reproductive health and fertility.


Steps that may help reduce the risk of PID include:

  • Regular STI screening

  • Using barrier contraception such as condoms

  • Prompt treatment of genital infections

  • Having pelvic procedures performed by experienced specialists

  • Avoiding vaginal douching


Understanding risk factors and seeking treatment early can help reduce the likelihood of recurrent infection and complications.

When to See a Specialist

You should seek medical advice if you experience:

  • Persistent pelvic pain

  • Unusual vaginal discharge

  • Fever with pelvic discomfort

  • Bleeding between periods

  • Bleeding after sex

  • Pain during intercourse

  • Pain when urinating

  • Symptoms following a positive STI test


Early assessment allows prompt treatment and helps reduce the risk of fertility problems and other complications.

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