Let's Talk About Sex: Pelvic Inflammatory Disease and Fertility
Today marks the start of sexual health week 2018. The campaign, organised by the Family Planning Association, runs from 24th to 30th September. The sexual health charity aims to provide support and information on healthy relationships, sex, contraception, STI’s, and this year’s topic, consent.
Consent is the key factor that underpins sexual health and wellbeing and can often be the unfortunate link between sex and diseases; such as pelvic inflammatory disease. In order to raise awareness of the dangers of pelvic inflammatory disease, the team at Kegel8 have produced a useful guide to help you understand the disease.
What is Pelvic Inflammatory Disease?
Pelvic inflammatory disease (PID) is a bacterial infection that affects the female upper genital tract. This includes the womb, ovaries, fallopian tubes, and it can even reach the lining of the abdomen. Luckily for men, they cannot suffer from PID; but men can act as a diseased transport link, carrying and transmitting the bacteria to future sexual partners.
In the UK, PID mainly affects women who are sexually active, aged between 15-24.
If left untreated, PID can quickly result in abscesses in the ovaries and fallopian tubes. This is a huge worry if you’re concerned about your fertility as the abscesses can irreparably scar the tubes, making them too narrow for eggs to pass through into the womb. It can also make you 6 times more likely to have an ectopic pregnancy (where the pregnancy is in the fallopian tubes rather than the womb).
Is Pelvic Inflammatory Disease Painful?
PID can be painful, especially during sex and urination. Even after PID is treated, 18% of women will develop chronic pelvic pain that remains.
What Causes Pelvic Inflammatory Disease?
1 in every 4 cases of PID is caused by a sexually transmitted disease (STD). However, it can also be caused by directly catching the bacteria from a sexual partner or receiving damage to the cervix which allows normal vaginal bacteria to reach higher up the genital tract.
- Sexually transmitted diseases (STD’s) – The most common being chlamydia and gonorrhoea, these bacterial infections occur in the vagina and cervix in women, or the penis and testicles in men. They are spread between sexual partners during unprotected sex. When the infection spreads and reaches higher reproductive organs in women, PID occurs.
- Unprotected sex with a carrier – As well as being a way to catch an STD, if you have unprotected sex with either a man or woman that carries the bacteria that causes PID, it can transfer to you.
- Vaginal bacteria – Bacteria that lives in the vagina can cause PID in the reproductive organs if it is able to get past the cervix. This can occur if you have:
- a damaged cervix (which can occur from childbirth or a miscarriage)
- had PID before
- had a procedure that opened the cervix (such as an abortion or had an intrauterine contraceptive device (coil) fitted)
- used a vaginal douche
You can reduce your risk of developing PID by using protection during sex to avoid catching an STD and treating any STD’s you develop as soon as possible.
What are the Symptoms of Pelvic Inflammatory Disease?
The symptoms of PID are common with other conditions that result in pelvic pain. They increase in severity as the condition develops and irreparable damage is done.
- Pelvic pain and discomfort in the lower abdomen and pelvis (this pain is not always present)
- Pain felt deep inside the pelvis during sex (dyspareunia)
- Increased vaginal discharge that may be yellow or green in colour
- A fever of 38°C
- Pain during urination
- Urge incontinence
- Vaginal bleeding outside of the normal menstrual cycle, and often after sex
- Very heavy periods (menorrhagia)
- Very painful periods (dysmenorrhoea)
- Nausea and vomiting
Conditions that share similar symptoms include appendicitis and ectopic pregnancy. If you are pregnant when suffering with PID, you will be urgently admitted to hospital to protect your baby during the treatment.
How Can You Treat Pelvic Inflammatory Disease?
There is a 1 in 10 risk of becoming infertile as a result of PID, with your probability increasing the longer you go untreated. Diagnosing PID is not a straight forward task, so your GP may recommend that you begin treatment if your history suggests PID is likely, and if there is no other obvious cause for the pain.
You should be aware that any damage that has already occurred to your reproductive organs cannot be resolved through the below treatments.
- Antibiotics – A combination of antibiotics will be prescribed in a 2-week course. Antibiotics are used to treat all the different types of bacteria that may be causing your PID. Recent sexual partners will also be treated with antibiotics, even if they don’t show any symptoms and/or are male. If you have any pelvic abscesses, these will also be treated with antibiotics and may require draining.
- Pain relief – Over the counter pain medications, such as paracetamol and ibuprofen, will help to relieve your symptoms whilst you recover. However, you should always check the instructions if you are taking pain relief medications alongside antibiotics!
- Abstinence from sex – Unfortunately, whilst you are being treated for PID, you should avoid sex and inform recent partners that they need to be tested to stop further infection. Following successful treatment of your PID, you should always remember to ‘wrap it up’ during sex and speak to your doctor before trying to conceive.
- Intrauterine contraception (coil) advice – If you have intrauterine contraception fitted, it is recommended that it remains in place until the antibiotic treatment has begun.
Help to raise awareness during Sexual Health Week 2018 by spreading information and support in your community.
For more information about the sexual healthy charity, visit Family Planning Association.
 Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID). [online] Centers for Disease Control and Prevention, 2015. [viewed 10/05/18]. Available from: https://www.cdc.gov/std/tg2015/pid.htm
 Das, B. B. Ronda, J. Trent, M. (2016). Infection and Drug Resistance. Pelvic inflammatory disease: improving awareness, prevention, and treatment. [online] 9, p191-197. [viewed 18/05/18]. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998032/
 Family Planning Association (2018) Sexual Health Week [online]. FPA [accessed 22/08/2018]. Available from https://www.fpa.org.uk/campaigns/sexual-health-week
 NHS Trust. (2015b). Pelvic inflammatory disease: Overview. [online] National Health Service, 2015. [viewed 10/05/18]. Available from: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/
 NICE. (2015). Pelvic inflammatory disease: Scenario: Management. [online] National Institute for Health and Care Excellence, 2015. [viewed 10/05/18]. Available from: https://cks.nice.org.uk/pelvic-inflammatory-disease#!scenario
 Soper, D. E. (2010). Obstetrics & Gynecology. Pelvic inflammatory disease. [online] 116(2), p419-428. [viewed 01/05/2018]. Available from: http://insights.ovid.com/pubmed?pmid=20664404