PREVENT COMPLICATIONS OF PID: Be alert for the symptoms and signs of PID. Get medical attention immediately if any symptoms are present. Remember, mild symptoms don't mean a mild infection.

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YOUNG WOMEN AND PID: Young women have the highest risk for PID: 75 percent of women with PID are under 25 years of age. Teenagers have the highest risk for PID, two to four times higher than women over 20. In fact, the U.S. Centers for Disease Control estimates that if the current trend continues, half of the women who turned 15 in 1990 will have PID by the year 2000.

The reasons for the higher risk of PID among teenagers are not completely understood, but it is believed that a teenager's immune system may be less developed, especially in response to sexually transmitted diseases, and this may make her more vulnerable to pelvic infection. In fact, the U.S. Centers for Disease Control is now recommending that young women delay the start of intercourse for several years, because of this increased vulnerability and the impact an episode of PID can have on a young woman's health.

Also, teenage women have the highest rate of cervical chlamydial infections in Canada and are therefore more likely to develop PID. Teenagers are also less likely to use barrier methods of birth control. They are more likely to have more sex partners and have cervical mucous that is easier for bacteria to penetrate. In addition, a type of cervical cell called columnar epithelia, is more pronounced on the cervixes of adolescents, and both chlamydia and gonorrhea like to grow in these cells.

BIRTH CONTROL CHOICE: A woman's choice of birth control influences her risk of developing PID. This is a complex subject, and more details can be obtained from the Canadian PID Society, but here is a brief outline.

Barrier methods of birth control (condoms, diaphragms) considerably reduce a woman's risk of cervical STD infections, PID, ectopic pregnancy, and infertility. Condoms also offer protection against other serious diseases such as herpes and the AIDS-causing HIV virus. Both condoms and diaphragms should be used with a spermicide, and must be used regularly and properly to be effective.

Birth control pills do not offer protection against cervical STD infections. Women who use birth control pills actually have higher rates of cervical chlamydial infections, which is the most common cause of PID. However, there is some evidence that women who use oral contraceptives may have lower rates of diagnosed PID, possibly because the hormones in the pill are thought to thicken the cervical plug and make it harder for bacteria to ascend into the reproductive organs. For this reason, birth control pills are often prescribed for women after an episode of PID.

There is a lot of disagreement about the relationship of birth control pills and PID, and many researchers do not believe that birth control pills really offer protection against PID. This is because oral contraceptives increase the risk of cervical chlamydial infections which are the most common cause of PID. They increase the risk of pelvic infection in animals and they improve the ability of bacteria to attach to fallopian tube tissue in the laboratory. In addition, if birth control pills protect against PID, it would be expected that women who use birth control pills would also have lower rates of ectopic pregnancy and infertility, two of the most common consequences of PID, but this is not the case. For these reasons, many believe birth control pills do not protect against PID.

IUD'S (INTRAUTERINE DEVICES): IUD's increase a woman's risk of PID about two-fold, although the risk for modern IUD's is much lower than for older IUD's. This risk is mainly due to the opening of the cervix to insert the IUD. Some research has also shown that women who use IUD's have higher rates of infertility, although there is much controversy and disagreement about this finding.

VIRUSES AND OTHER MICROORGANISMS: Almost all of the research on pelvic inflammatory disease focuses on pelvic infection caused by bacteria. We really don't know what role viruses, yeast, funguses etc may play in pelvic infection. There are a few studies showing that herpes can cause infection in the lining of the uterus, and one recent study showing that yeast can infect the lining of the abdominal cavity (peritonitis), but basically the possibility that viruses and other organisms can cause PID has not really been explored.