Pelvic Inflammatory Disease (PIH)

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PIH) is an infection of the female reproductive organs. The pelvis is in the lower abdomen and includes the fallopian tubes, ovaries, cervix, and uterus.

According to the U.S. Department of Health and Human Services, the condition affects 5 percent of women in the United States.

Several different types of bacteria can cause PIH, including the same bacteria that causes the sexually transmitted infections (STIs) gonorrhea and chlamydia. What commonly occurs is that bacteria first enter the vagina and cause an infection. Over time, this infection can spread to the pelvic organs.

PIH can be extremely dangerous and life-threatening if the infection spreads to your blood. If you suspect you may have an infection, see your doctor as soon as possible.

Risk factors for pelvic inflammatory disease

Your risk of pelvic inflammatory disease is increased if you have gonorrhea or chlamydia, or have had a previous STI. However, you can develop PIH without having any STDs.

Other factors that can increase your risk of PIH include:

• having sex under 25
• having multiple sex partners
• having sex without a condom
• have recently had an intrauterine device (IUD) inserted
• vaginal douche
• with a history of pelvic inflammatory disease

Pelvic inflammatory disease symptoms

Some women with pelvic inflammatory disease have no symptoms. For women with symptoms, these may include:

• lower abdominal pain (most common symptom)
• upper abdominal pain
• fire
• pain sex
• painful urination
• irregular bleeding
• increased or foul-smelling vaginal discharge
• tiredness

Pelvic inflammatory disease can cause mild or moderate pain. However, some women have severe pain and symptoms such as:

• sharp pain in the abdomen
• vomiting
• fainting
• high fever (greater than 101°F)

Call your doctor right away or go to the emergency room if you have severe symptoms. The infection may have spread to your bloodstream or other parts of your body. This can be life threatening.

Tests for pelvic inflammatory disease

PIH diagnosis

Your doctor can diagnose PIH after hearing your symptoms. In most cases, your doctor will run tests to confirm the diagnosis.

Tests may include:

• pelvic exam to check your pelvic organs
• cervical culture to check for cervical infections
• urine test to check your urine for blood, cancer, and other signs of disease

After collecting the samples, your doctor sends these samples to a lab.

Damage assessment

If your doctor finds that you have pelvic inflammatory disease, they may do further testing and check your pelvic area for damage. PIH can leave scars on your fallopian tubes and cause permanent damage to your reproductive organs.

Additional tests include:

• Pelvic ultrasound. This is an imaging test that uses sound waves to create pictures of your internal organs.
• Endometrial biopsy . In this outpatient procedure, the doctor removes a small sample from the lining of the uterus and examines it.
• laparoscopy . Laparoscopy is an outpatient procedure in which the doctor inserts a flexible instrument through an incision in your abdomen and takes pictures of your pelvic organs.

Pelvic inflammatory disease treatment

Your doctor will likely have you take antibiotics to treat PIH. Because your doctor doesn’t know the type of bacteria causing your infection, they may give you two different types of antibiotics to treat a variety of bacteria.

Your symptoms may improve or prolong within a few days of starting treatment. However, you should finish your medicine even if you feel better. Stopping your medication early may cause the infection to return.

If you are sick or pregnant, your doctor may send you to the hospital for treatment if you cannot swallow pills or find an abscess (pocket of pus caused by the infection) in your pelvis.

Pelvic inflammatory disease may require surgery. This is rare and only necessary if an abscess has ruptured in your pelvis or if your doctor suspects an abscess is about to burst. It may also be necessary if the infection does not respond to treatment.

The bacteria that cause PIH can be spread through sexual contact. If you are sexually active, your partner should also receive treatment for PIH. Men can be silent carriers of bacteria that cause pelvic inflammatory disease.

If your partner does not receive treatment, your infection may recur. You may be asked to abstain from sexual intercourse until the infection has resolved.

Ways to prevent pelvic inflammatory disease

You can lower your risk of PIH by:

• have safe sex
• getting tested for sexually transmitted infections
• avoid touch
• Wipe from front to back after using the bathroom to prevent bacteria from entering your vagina.

Long-term complications of pelvic inflammatory disease

If you think you have PIH, make your doctor’s appointment. Other conditions, such as a UTI, can feel like pelvic inflammatory disease. However, your doctor can test for PIH and rule out other conditions.

If you don’t treat your PIH, your symptoms may worsen and lead to problems such as:

• infertility, inability to conceive a child
• ectopic pregnancy, a pregnancy that occurs outside of the uterus
• chronic pelvic pain, lower abdominal pain caused by scarring of the fallopian tubes and other pelvic organs

The infection can also spread to other parts of your body. If it spreads to your blood, it can be life-threatening.

Long-term outlook for pelvic inflammatory disease

Pelvic inflammatory disease is a very treatable condition and most women make a full recovery.

With this, to the Centers for Disease Control and Prevention 1 in 8 women with a history of PIH will have a hard time conceiving. Pregnancy is still possible for most women.

Resources:

Das BB et al. (2016). Pelvic inflammatory disease: Improving awareness, prevention and treatment.

Pelvic inflammatory disease. (2015).

Pelvic inflammatory disease. (2019).

Pelvic inflammatory disease (PID) – CDC fact sheet. (2015).