EPIDEMIOLOGY OF PELVIC INFLAMMATORY DISEASE

The epidemiologic study of pelvic inflammatory disease (PID) is hinder ed by symptoms that differ substantially from case to case, and by a s ubstantial number of ''silent'' cases with few Or no symptoms. Demogra phic data indicate that PID is primarily a disease of the young. Race also appears to be a determinant, but whether for biologic or sociolog ic reasons is not known. Women who are not married face a greater risk for PID than married women. The majority,of PID cases are associated with sexually transmitted diseases. Consistent with this finding is th e pattern of risk factors related to sexual behavior: young age at fir st intercourse, high frequency of intercourse, and a large number of s exual partners all increase the risk of PID. On the other hand, barrie r methods of contraception appear to reduce the risk of PID, as does o ral contraception. Perhaps the best publicized risk factor for PID is another contraceptive, the intrauterine device (IUD). The increased ri sk of PID in IUD users appears to be confined to new users and women a t high risk of sexually transmitted disease infection. Douching and ci garette smoking may also be associated with the development of PID, bu t the evidence is weak.