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Pelvic inflammatory disease is a term for a variety of infections affecting a woman's upper reproductive organs, including the uterus, the ovaries, and the two fallopian tubes that serve as passageways between the ovaries and the womb. PID occurs when disease-causing microorganisms in the lower genital tract rise through the opening in the cervix, which separates the uterus and the vagina (see "How PID infects the reproductive organs").
Most cases of PID are acquired during sexual intercourse with a partner who has a sexually transmitted disease (STD), primarily chlamydia or gonorrhea. Up to 40% of women who get one of these infections and don't have it adequately treated will wind up with PID. PID can occur after a miscarriage, abortion, or any other procedure that opens the cervix or abdomen, allowing disease-causing germs easy entry to the reproductive organs.
PID can spread beyond the reproductive tract, causing serious and potentially deadly complications. Each year about 250,000 US women are hospitalized because of PID, and more than 150 die.
Even aside from the immediate dangers, the long-term effects of PID can be devastating. PID can permanently scar and damage the fallopian tubes, causing blockage of the tubes. About 12% of women suffer enough tubal damage from one episode of PID to become infertile. After three episodes of PID, the infertility rate reaches 50%.
PID also increases the risk of an ectopic pregnancy, in which the fertilized egg gets trapped in the tube and begins to grow there. Without treatment, the tube may burst, causing internal bleeding and possibly death. Finally, tissue damage can leave many women with chronic pelvic pain long after the PID infection is gone.
Who's at Risk for PID?
Anyone can get PID, but the risk is highest for women who:
- are younger than 25 years old
- have more than one sexual partner
- begin having sex at an early age
- have had an STD in the past
- have had PID in the past
- douche several times a month
- use an IUD for contraception
WHO CAN GET PID?
Although anyone can get PID, the disorder is especially common in women under 25 years old (see "Who's at Risk for PID?"). As with STDs in general, the more sexual partners a woman has, the more likely she is to get PID. Even if you have only one sexual partner, you can still get PID if your partner is having intercourse with other people. A woman who has only one partner (who is also sexually exclusive) has a very low risk of PID.
Using an intrauterine device (IUD) for birth control increases the risk of PID somewhat, especially for the first few months after the device is inserted. Douching has also been linked to PID, perhaps because it pushes vaginal organisms up through the cervical opening.
Once you've had one bout of PID, you're more likely to have another, regardless of your behavior. These later infections are not always caused by a new STD. Instead, they commonly result from bacteria that were not completely wiped out by earlier therapy. PID also seems to leave the reproductive tract more sensitive to vaginal organisms that wouldn't ordinarily cause a problem.
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