Pelvic Inflammatory Disease

  • Basics

    Pelvic inflammatory disease (PID) is an infection of the internal female reproductive organs Figure 01. Pelvic inflammatory disease (PID) is an umbrella term for infection of various portions of the female internal reproductive system. It generally occurs when an infection invades the uterus (endometritis). Infection may then spread to the fallopian tubes (salpingitis), ovaries (oophoritis), and even the surrounding tissues.

    Click to enlarge: Pathways of PID Progression

    Figure 01. Pathways of PID Progression

    PID is a potentially serious illnesses, that can cause tubal scarring and lead to infertility and ectopic pregnancies. The National Institutes of Health estimates that 20% of women who have PID become infertile. Additionally, a history of PID can increase the likelihood ectopic pregnancies, a situation in which a fertilized egg lodges in the fallopian tubes rather than implanting in the uterus. Women with ectopic pregnancies are at risk for heavy bleeding, and emergency surgery is generally needed.

  • Causes

    Unprotected sexual activity is the main cause of PID. PID occurs when a bacterial organism enters the cervix and travels to any portion or all of the internal reproductive system. Bacterial transmission most commonly occurs during unprotected vaginal sex.

    Two of the most common infections that cause PID are the sexually transmitted diseases gonorrhea (caused by the bacterium Neisseria gonorrhoeae) and chlamydiosis (caused by the bacterium Chlamydia trachomatis).

    Any activity or procedure that injures the cervical opening, thus giving bacteria better access to the reproductive organs, can lead to PID. In addition to unprotected sexual activity, other activities or procedures can predispose the female reproductive system to infection, including:

    • Delivering a child through the vagina (whether it's a normal delivery, a miscarriage, or an abortion)
    • Medical procedures that use tubes (such as injection of a dye for certain tests)
    • Douching, which can wash bacteria from the outer vaginal area up and into the reproductive system.
    • Using an intrauterine device (IUD), a birth control method that has been known to carry infection into the reproductive system.
    • Delivering a child by caesarean section—a procedure that has been shown to carry an increased risk of postpartum (after childbirth) uterine infection

    Various non-sexually-transmitted diseases can also cause PID. Some examples of non-sexually-transmitted diseases that can cause PID include actinomycosis, which is a relatively rare bacterial infection that generally enters through the mouth; schistosomiasis (also relatively rare in the U.S.), an infection caused by a parasite; and tuberculosis.

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