Pelvic inflammatory disease (PID) is a general term for an infection affecting the female reproductive organs. This condition can involve the uterus, fallopian tubes, and ovaries. PID develops when various types of bacteria spread from the vagina and cervix into these upper reproductive structures. If left unaddressed, it can lead to chronic complications.
Sexually Transmitted Infections as Primary Causes
Sexually transmitted infections (STIs) are a common origin for pelvic inflammatory disease, with Chlamydia trachomatis and Neisseria gonorrhoeae being particularly significant. These bacteria, acquired through unprotected sexual contact, initially infect the cervix. If these lower genital tract infections are not promptly treated, the bacteria can ascend into the uterus, fallopian tubes, and ovaries. This upward spread leads to inflammation and infection in these organs.
For example, Neisseria gonorrhoeae, the bacterium causing gonorrhea, can spread from the cervix to the uterus and fallopian tubes, resulting in PID. Chlamydia trachomatis can similarly lead to PID if left untreated. These two STIs frequently account for a notable percentage of cases. A significant challenge with these infections is their often asymptomatic nature. Many individuals may not experience noticeable symptoms, allowing the bacteria to persist and spread unnoticed. This means the infection can progress from the lower reproductive tract to the upper organs before a person realizes they are infected, facilitating the development of pelvic inflammatory disease.
Other Bacterial Entry Points
While STIs are a frequent cause, bacteria can also enter the reproductive tract and lead to pelvic infections through other pathways. Medical procedures that involve the cervix can create an opportunity for bacteria to ascend. For example, the insertion of an intrauterine device (IUD) carries a small, temporary risk of PID. This risk is reduced when women are screened for STIs before IUD insertion.
Additionally, events like abortion, miscarriage, or childbirth can temporarily disrupt the natural barrier of the cervix, making the upper reproductive tract more susceptible to bacterial entry. After an abortion, infection in the uterus is a primary concern, often caused by leftover pregnancy tissue or the introduction of bacteria during the procedure. A serious infection of the uterus, known as septic abortion, can occur shortly before, during, or after an abortion or miscarriage.
The natural balance of bacteria within the vagina can be disturbed, leading to an overgrowth of certain microorganisms. These bacteria, normally present in the vaginal flora, can then ascend into the uterus and fallopian tubes, causing an infection. Bacterial vaginosis, a condition characterized by an imbalance of vaginal bacteria, has been associated with PID. This highlights that not all pelvic infections originate from sexually transmitted pathogens.
Factors Increasing Risk
Certain factors do not directly cause pelvic infections but can significantly increase the likelihood of developing PID if causative bacteria are present. Having multiple sexual partners increases the chance of exposure to STIs, which are common precursors to PID. Engaging in unprotected sexual intercourse removes a barrier against bacterial transmission, raising the risk of acquiring infections that can lead to PID.
A history of previous pelvic inflammatory disease episodes also elevates the risk of recurrence. Prior infections can cause changes in the reproductive tract, making it more vulnerable to subsequent bacterial invasions. Furthermore, practices like douching can disrupt the natural bacterial balance in the vagina and potentially push existing bacteria upwards into the reproductive organs. Medical organizations generally advise against douching due to its potential to upset vaginal flora and mask infection symptoms.