Pelvic inflammatory disease is an infection which passes from the vagina (A) through the uterus (B) to other parts of the pelvis.

What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is an infection that passes from the vagina through neck of the womb (cervix), the womb (uterus) and up to the Fallopian tubes. The ovaries are sometimes also involved. Bacteria and other micro-organisms can find their way through the vagina and the cervix to the internal reproductive organs. A bacterial infection can cause inflammation in these organs and their surroundings. This most commonly occurs in the Fallopian tubes.

What causes PID?
In some women, PID may result from a termination of pregnancy or following childbirth. Occasionally, it may be as a result of having sex with a new partner. But often no specific reason can be found. In the UK the 'bug' most commonly responsible for PID is Chlamydia.

What are the symptoms of PID?
PID causes tenderness and pain in one or both sides of the lower abdomen. At the same time, it can cause fever and general discomfort. Finally, the infection can be accompanied by heavy, painful periods and sometimes a vaginal discharge.

How does the doctor make a diagnosis?
If, in a pelvic examination, the doctor detects tenderness and perhaps even a lump next to the uterus, then PID is a possible cause. Blood tests can also be used to detect signs of infection.

Usually these symptoms and signs of infection are sufficient for the doctor to make a diagnosis of PID but, sometimes, it may be necessary to also examine the inside of the pelvis using laparoscopy to detect any inflammatory changes.

Samples are also taken from the neck of the womb to try to identify the organism responsible for the infection.

How is PID treated?
The doctor will normally prescribe antibiotics and advise the patient to keep warm and rest at home - hospitalisation is not usually necessary. In most cases, the inflammation will subside in a week or two. However, if the pain and soreness remain, this could be a sign that the infection has not gone away and might even have returned. Fortunately, with proper treatment, this is uncommon. If Chlamydia is detected then the woman's sexual partner should also be tested. If he is infected, he will also require treatment.

What complications may arise from PID?
Even though PID is a relatively harmless condition, if it is not treated quickly and effectively, it can result in permanent damage to the Fallopian tubes. This makes it more difficult for eggs and sperm to pass through and increases the risk of infertility or an ectopic pregnancy.

If the first or subsequent episodes of inflammation are not adequately treated then the condition can become chronic. If this happens, abscesses can form in the pelvis and surgery is often required. This may involve the loss of a Fallopian tube, an ovary or, occasionally, the removal of the womb in a hysterectomy. Fortunately, most women seek advice early and treatment is prompt and appropriate.

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