Unsafe sexual practices that increase the likelihood of acquiring a sexually transmitted disease (STD) — such as unprotected sex with more than one partner — increase your risk of PID. The most common bacteria that cause PID also cause gonorrhea and chlamydia, and many women with these bacterial infections develop symptomatic PID.

• Back pain

• Chlamydia

Some forms of contraception may affect your risk of developing PID. Contraceptive IUDs may increase the risk of PID, but barrier methods such as condoms or diaphragms reduce the risk. Use of the birth control pill alone offers no protection against acquiring STDs. But the pill may offer some protection against the development of PID by causing your body to create thicker cervical mucus, making it more difficult for bacteria to reach your upper genital tract.

Bacteria may also enter the reproductive tract as a result of an IUD insertion, childbirth, miscarriage, abortion or removing a small piece of tissue from your uterine lining for laboratory analysis (endometrial biopsy).

A number of factors may increase your risk of PID, including:

• Being a young, sexually active woman (15 to 25 years old).

• Having multiple sexual partners.

• Using nonbarrier contraceptives. Barrier methods protect against PID.

• Having had an IUD inserted recently. Your risk is highest during the first four months after insertion.

• Douching regularly, which may flush bacteria higher into your genital tract and mask symptoms that might otherwise cause you to seek early treatment.

• Having a history of PID or any sexually transmitted disease.

See your doctor if you have signs and symptoms of PID, including:

• Pain in your lower abdomen and pelvis

• Unusual vaginal discharge with an unpleasant odor

• Irregular menstrual bleeding

• Pain during intercourse

• Low back pain

• Fever, fatigue, diarrhea or vomiting

• Painful or difficult urination

• Back pain

• Diarrhea

• Fatigue

• vomiting

Genital sores or rash, discharge with an odor, painful urination, or bleeding between menstrual cycles also can indicate an STD. If these signs and symptoms appear, stop having sex and see your doctor soon. Prompt treatment of an STD can help prevent PID.