Pelvic inflammatory disease (PID) is characterised by inflammation of a woman's reproductive organs (uterus, fallopian tubes and ovaries), which is caused by infection. It is generally an ascending infection, spreading from the lower genital tract (vulva and vagina) to the upper genital tract (uterus, ovaries, and fallopian tubes).  This condition is commonly seen in women aged 15 to 25 years. Over the past decade, the incidence of PID has decreased due to more women getting tested regularly for bacteria. However often it is seen in both outpatient clinics and emergency department settings. Pelvic inflammatory disease causes include different types of bacteria. However, PID is commonly caused by the bacteria from sexually transmitted infections (STIs) - Chlamydia trachomatis and Neisseria gonorrhoeae. Mycoplasma genitalium (another type of STI) is considered to be increasingly responsible for PID cases. Other causes of PID (Pelvic inflammatory disease) include: Vaginal infections (bacterial vaginosis) Ruptured appendix Bowel infection (gastroenteritis) Some surgical procedures such as dilatation and curettage Surgical abortion or intrauterine device (IUD) About 85% of PID cases occur by sexually transmitted bacteria that travel from the vagina to the cervix and up into the uterus, fallopian tubes and ovaries. A woman gets PID without having a sexually transmitted infection. In some cases, it may also be caused by the normal bacteria that found in the vagina. Sometimes, the bacterium moves up to the female reproductive organs because of douching (washing or cleaning the outside of the vagina using the water or a mixture of fluids to remove odour). Types of pelvic inflammatory disease (PID) are classified based on the duration of inflammation that follows as Acute PID (Pelvic inflammatory disease) Chronic PID (Pelvic inflammatory disease) Acute PID: Acute pelvic inflammatory disease is characterised by sudden or severe inflammation of the female reproductive organs (uterus, fallopian tubes, ovaries) due to infection. Chronic PID: Chronic pelvic inflammatory disease is characterised by persistent inflammation for a long time, which can lead to severe complications. Most pelvic inflammatory disease symptoms (female) are mild and may include one or more of the following signs and symptoms of pelvic inflammatory disease: Lower abdominal or pelvic pain (common) Vaginal discharge (yellow, green or fishy odour). Abnormal vaginal bleeding Dyspareunia (painful sex) Increased temperature Painful urination Bleeding and spotting after sex Pain in the upper right abdomen (rare) Regular reproductive health checkups are crucial for sexually active women since some individuals may not experience noticeable symptoms of pelvic inflammatory disease. However, PID symptoms might show extreme pain and fever if it is caused by a bacteria called gonorrhoea. Infection of reproductive organs leads to inflammation, which causes adhesions, scarring and partial or total obstruction (blockage) of fallopian tubes, resulting in infertility (difficulty conceiving), ectopic pregnancy (fertilized egg grows outside of the uterus), and chronic (long-term) pelvic pain. The following are the PID risk factors that include: Having untreated sexually transmitted infections (STIs) History of pelvic inflammatory disease Sexually active women under the age of 25 (common in 15-24 aged females) Having multiple (more) sex partners or a partner with more than one sex partner. Douche: washing or cleaning the outside of the vagina using a mixture of fluids or water to remove odour (which pushes the bacteria into reproductive organs and hides the signs of PID). Tubal ligation (a surgical procedure where fallopian tubes are permanently clipped, blocked, or removed) Recently inserted intra-uterine device (IUD) (risk is high in the first few weeks after inserting the IUD). Complications of pelvic inflammatory disease include three main conditions, as follows: Chronic pelvic pain Infertility Ectopic pregnancy Recurrent pelvic inflammatory disease Tubo-ovarian abscess (fallopian tubes and ovaries) If left untreated (not treated), pelvic inflammatory disease can lead to above-mentioned complications. Infections cause inflammatory damage to reproductive organs, which results in long-term (chronic) scarring and blockages (obstruction) in the fallopian tubes. Over time, changes in the fallopian tube can lead to difficulty conceiving due to the inability of a fertilised egg to travel into the uterus through the fallopian tube. As per the research studies, 18% of females aged between 20-24 with pelvic inflammatory diseases (PID) had developed chronic pain gradually, and 16.8% had difficulty in getting pregnant followed by 8.5% had experience ectopic pregnancies. Three or more episodes of PID can increase the risk of fallopian tube blockage (obstruction) by 75%.