PID is an infection of a woman's reproductive organs. The reproductive organs include the uterus (womb), fallopian tubes, ovaries, and cervix.

PID can be caused by many different types of bacteria. Usually PID is caused by bacteria from STIs. Sometimes PID is caused by normal bacteria found in the vagina.

PID affects about 5% of women in the United States.² Your risk for PID is higher if you:³

• Have had an STI
• Have had PID before
• Are younger than 25 and have sex. PID is most common in women 15 to 24 years old.
• Have more than one sex partner or have a partner who has multiple sexual partners
• Douche. Douching can push bacteria into the reproductive organs and cause PID. Douching can also hide the signs of PID.
• Recently had an intrauterine device (IUD) inserted.⁴ The risk of PID is higher for the first few weeks only after insertion of an IUD, but PID is rare after that. Getting tested for STIs before the IUD is inserted lowers your risk for PID.

A woman can get PID if bacteria move up from her vagina or cervix and into her reproductive organs. Many different types of bacteria can cause PID. Most often, PID is caused by infection from two common STIs: gonorrhea and chlamydia. The number of women with PID has dropped in recent years. This may be because more women are getting tested regularly for chlamydia and gonorrhea.⁵

You can also get PID without having an STI. Normal bacteria in the vagina can travel into a woman's reproductive organs and can sometimes cause PID. Sometimes the bacteria travel up to a woman's reproductive organs because of douching. Do not douche. No doctor or nurse recommends douching.

Many women do not know they have PID because they do not have any signs or symptoms. When symptoms do happen, they can be mild or more serious.

Signs and symptoms include:

• Pain in the lower abdomen (this is the most common symptom)
• Fever (100.4° F or higher)
• Vaginal discharge that may smell foul
• Painful sex
• Pain when urinating
• Irregular menstrual periods
• Pain in the upper right abdomen (this is rare)

PID can come on fast, with extreme pain and fever, especially if it is caused by gonorrhea.

To diagnose PID, doctors usually do a physical exam to check for signs of PID and test for STIs. If you think that you may have PID, see a doctor or nurse as soon as possible.

If you have pain in your lower abdomen, your doctor or nurse will check for:

• Unusual discharge from your vagina or cervix
• An abscess (collection of pus) near your ovaries or fallopian tubes
• Tenderness or pain in your reproductive organs

Your doctor may do tests to find out whether you have PID or a different problem that looks like PID. These can include:⁴

• Tests for STIs, especially gonorrhea and chlamydia. These infections can cause PID.
• A test for a urinary tract infection or other conditions that can cause pelvic pain
• Ultrasound or another imaging test so your doctor can look at your internal organs for signs of PID

A Pap test is not used to detect PID.

Your doctor or nurse will give you antibiotics to treat PID. Most of the time, at least two antibiotics are used that work against many different types of bacteria. You must take all of your antibiotics, even if your symptoms go away. This helps to make sure the infection is fully cured. See your doctor or nurse again two to three days after starting the antibiotics to make sure they are working.

Your doctor or nurse may suggest going into the hospital to treat your PID if:

• You are very sick
• You are pregnant
• Your symptoms do not go away after taking the antibiotics or if you cannot swallow pills. If this is the case, you will need IV antibiotics.
• You have an abscess in a fallopian tube or ovary

If you still have symptoms or if the abscess does not go away after treatment, you may need surgery. Problems caused by PID, such as chronic pelvic pain and scarring, are often hard to treat. But sometimes they get better after surgery.

Without treatment, PID can lead to serious problems like infertility, ectopic pregnancy, and chronic pelvic pain (pain that does not go away). If you think you may have PID, see a doctor or nurse as soon as possible.

Antibiotics will treat PID, but they will not fix any permanent damage done to your internal organs.

Maybe. Your chances of getting pregnant are lower if you have had PID more than once. When you have PID, bacteria can get into the fallopian tubes or cause inflammation of the fallopian tubes. This can cause scarring in the tissue that makes up your fallopian tubes.

Scar tissue can block an egg from your ovary from entering or traveling down the fallopian tube to your uterus (womb). The egg needs to be fertilized by a man's sperm and then attach to your uterus for pregnancy to happen. Even having just a little scar tissue can keep you from getting pregnant without fertility treatment.

Scar tissue from PID can also cause a dangerous ectopic pregnancy (a pregnancy outside of the uterus) instead of a normal pregnancy. Ectopic pregnancies are more than six times more common in women who have had PID compared with women who have not had PID.⁶ Most of these pregnancies end in miscarriage.

You may not be able to prevent PID. It is not always caused by an STI. Sometimes, normal bacteria in your vagina can travel up to your reproductive organs and cause PID.

But, you can lower your risk of PID by not douching. You can also prevent STIs by not having vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
• Do not douche. Douching removes some of the normal bacteria in the vagina that protect you from infection. Douching may also raise your risk for PID by helping bacteria travel to other areas, like your uterus, ovaries, and fallopian tubes.
• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Yes. It is possible to get PID, or an STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of PID.

For more information about PID, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, HHS
  Phone Number: 800-232-4636
• National Institute of Allergy and Infectious Diseases (NIAID), NIH, HHS
  Phone Number: 866-284-4107 (TDD: 800-877-8339)
• American Sexual Health Association
  Phone Number: 800-227-8922
• Planned Parenthood
  Phone Number: 800-230-7526

• Chlamydia fact sheet
• Douching fact sheet
• Genital herpes fact sheet
• Genital warts fact sheet
• Gonorrhea fact sheet
• HIV/AIDS
• Human papillomavirus (HPV)
• Pap test fact sheet
• Pregnancy
• Sexually transmitted diseases fact sheet
• Sexually transmitted infections, pregnancy, and breastfeeding
• Syphilis fact sheet
• Trichomoniasis fact sheet

1. Centers for Disease Control and Prevention. (2014). 2013 Sexually Transmitted Diseases Surveillance.
2. Leichliter, J., Chandra, A., Aral, S.O. (2013). Correlates of Self-Reported Pelvic Inflammatory Disease Treatment in Sexually Experienced Reproductive-Aged Women in the United States, 1995 and 2006–2010. Sex Transm Dis; 40(5):413–418.
3. Centers for Disease Control and Prevention. (2015). PID.
4. Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID).
5. Centers for Disease Control and Prevention. (2014). STDs in Women and Infants.
6. Weström, L., Joesoef, R., Reynolds, G., Hagdu, A., Thompson, S.E. (1992). Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sexually Transmitted Diseases; 19(4): 185–192.