Signs You Might Have Pelvic Inflammatory Disease

About 4.4 percent of sexually active American women are diagnosed with pelvic inflammatory disease (PID) at some point during their reproductive years. The infection can have serious consequences, so diagnosing it early is essential. Yet symptoms are often vague or minimal, making detection a difficult task.

A medical overview of PID

Pelvic inflammatory disease is an infection that occurs in one or more of the upper female reproductive organs: ovaries, fallopian tubes, uterus. It most commonly results from untreated sexually transmitted infections (STIs)—chlamydia and gonorrhea are the two biggest culprits—when bacteria move through the vagina and then spread to the reproductive tract.

Less commonly, PID may result after bacteria enter the reproductive tract after childbirth, miscarriage or abortion. Very rarely, a woman develops PID after the insertion of an intrauterine device (IUD) or other pelvic medical procedures.

Sexually active women under age 25 are most likely to get PID, and your risk increases if you have unprotected sex, sex with multiple partners, a history of PID or STIs, or if you douche regularly. Due to the wide array of symptoms and a significant discrepancy in severity, PID can be difficult to diagnose. It's often treated with combinations of antibiotics based on your doctor's findings and suspicions alone, without a specific diagnostic test.

Risks & long-term consequences

Early detection and treatment are essential when it comes to PID. Untreated, the disease can result in scar tissue and/or abscesses in the reproductive tract, which can cause long-term damage, including infertility or difficulty getting pregnant. The risk of infertility increases if a woman has multiple cases of PID or does not seek treatment quickly. Severe untreated PID can also lead to removal of the uterus, ovaries and fallopian tubes.

Tubo-ovarian abscesses are another risk of untreated PID; if they rupture, they can spread infection further through the abdomen. PID can also cause a potentially life-threatening ectopic pregnancy—the result of scar tissue in the fallopian tube that blocks the fertilized egg from reaching the uterus—as well as chronic pelvic pain due to scar tissue in the organs, which typically causes increased pain during sex or ovulation.

Signs & symptoms

Early PID may cause only very mild symptoms or none at all, so women may not realize something is wrong.

Pelvic and/or lower abdominal pain, mild or severe, is a common symptom of PID. Other common symptoms include:

• Abnormal or foul-smelling vaginal discharge
• Vaginal bleeding after sex or when you're not having your period
• Longer, heavier or more painful periods
• Extreme fatigue
• Frequent or painful urination
• Pain during sex (dyspareunia)
• Fever, with or without chills

When to see a doctor

Any signs or symptoms of PID should be evaluated in a timely manner, but certain symptoms indicate the need for urgent treatment. Deep, severe pelvic or lower abdominal pain typically occurs in more severe cases of PID (or as a result of another serious problem in the reproductive tract or lower abdomen). Extreme pain in this region should be evaluated immediately by your doctor. Similarly, seek immediate care if you have a fever higher than 101 degrees Fahrenheit, extreme nausea and vomiting, foul vaginal discharge, or signs of shock, such as fainting.

Prevent PID

If you are having sex with multiple partners or with someone who has multiple partners, practice safer sex. For example, use condoms or other barrier methods regularly. You should be tested for STIs at every annual gynecology appointment, and anytime you have (or think you may have) an STI or pelvic symptoms. Ask your partner(s) about their condom use and STI history, and when they were last tested for infection.

An important point: don't douche. Gynecologists and medical organizations advocate against using douche, because it alters the natural pH levels of bacteria in your vagina and creates the perfect setting for bacteria to enter and cause infections such as bacterial vaginosis and, you guessed it, PID. In fact, studies have shown women who douche are 73 percent more likely to develop PID. (Douching may also increase your risk of pregnancy complications and cervical cancer, and, contrary to popular belief, it does not have any known medical advantages.)

Stay in tune with your body and act quickly if you notice any symptoms. PID can be serious, but you can detect it early or prevent it entirely, which will protect your reproductive system.