Background: Pelvic inflammatory disease (PID) has traditionally been associated with younger women of reproductive age, with limited attention given to perimenopausal women. Aim: This study assessed the prevalence, risk factors, awareness, and health-seeking behaviours related to PID among reproductive and perimenopausal women in Delta State, Nigeria. 

Methodology: A descriptive cross-sectional survey was conducted among 400 women aged 20–55 years recruited from healthcare centres, markets, religious institutions, and community gatherings using multistage sampling. Data were collected using a structured questionnaire and analysed using descriptive and inferential statistics. 

Results: The overall prevalence of PID was 60%, with significantly higher prevalence among perimenopausal women (75%) compared with reproductive-aged women (45%) (Z = –6.12, p < 0.001). Symptoms significantly associated with PID included irregular menstruation (t = 16.31), dyspareunia (t = 14.82), pelvic pain (t = 15.10), frequent urination (t = 11.22), and difficulty conceiving (t = 13.40) (p < 0.001). Major risk factors included previous sexually transmitted infections, intrauterine device use, multiple sexual partners, history of abortion, and pelvic surgery (p < 0.01). Women in polygamous marriages showed nearly threefold higher odds of PID (OR = 2.95, p < 0.001). 

Conclusion: These findings highlight the influence of clinical, behavioural, and socio-cultural factors on PID prevalence and emphasizes the need for targeted public health interventions.

Pelvic inflammatory disease (PID) is a major public health and gynaecological condition characterized by inflammation of the upper female reproductive tract, including the endometrium, fallopian tubes, and peritoneum [1, 2]. Although traditionally associated with younger women, emerging evidence indicates that PID also affects perimenopausal women, who remain underrepresented in research and health policy despite biological and behavioural changes that may increase susceptibility to genital tract infections [3, 4, 5]. Women’s health during midlife is influenced by physiological, sociocultural, and environmental factors, highlighting the need for integration of sexual and reproductive health services into menopausal care, particularly in low-resource settings [6, 7]. 

PID has a multifactorial aetiology, most commonly involving Chlamydia trachomatis and Neisseria gonorrhoea, although polymicrobial infections associated with bacterial vaginosis and Mycoplasma genitalium are increasingly recognized [8, 9, 10, 11]. Untreated infections can result in infertility, chronic pelvic pain, ectopic pregnancy, and increased risk of ovarian malignancy [12,13]. Reproductive tract infections remain major contributors to female morbidity globally, with sub-Saharan Africa disproportionately affected due to limited STI prevention, screening, and healthcare access [14, 15, 16]. Risk factors for PID include multiple sexual partners, unprotected intercourse, previous STIs, unsafe abortion, and postpartum infections [17,18]. Perimenopausal women experience additional biological vulnerabilities due to declining oestrogen levels, reduced vaginal mucosal immunity, and age-related immune changes that increase susceptibility to infection [19, 20, 21]. Psychosocial factors such as marital instability, economic vulnerability, and misconceptions regarding STI risk during midlife further contribute to exposure [22, 23, 24]. Cultural stigma surrounding sexual activity among older women may delay healthcare seeking and complicate diagnosis, particularly as symptoms may be nonspecific [25, 26, 27, 28].

Untreated or recurrent PID can lead to infertility, chronic pelvic pain, sexual dysfunction, psychological distress, and increased healthcare costs [29, 30, 31, 32, 33]. In Nigeria, limited research focusing on perimenopausal women contributes to low clinical suspicion and under-treatment [34, 35]. Therefore, this study assessed the prevalence, risk factors, awareness, and health-seeking behaviors related to PID among reproductive and perimenopausal women in Delta State, Nigeria.              

2.1 Research Design

This study employed a descriptive cross-sectional survey design to assess the prevalence, awareness, risk factors, and health-seeking behaviours related to pelvic inflammatory disease (PID) among reproductive and perimenopausal women. The choice of a descriptive cross-sectional survey design is based on its suitability for capturing information at a single point in time, making it ideal for studying prevalence, knowledge, awareness, and experiences related to PID among the target population.

2.2 Study Area

The study was conducted in Delta State, Nigeria. Delta State, located in the South-South geopolitical zone of Nigeria, has a diverse population with varying socio-economic backgrounds, making it an ideal location. Six Local Government Areas (LGAs) representing urban, semi-urban, and rural populations were selected which are Oshimili South, Ethiope East, Ughelli North, Warri South, Ndokwa West, and Patani LGAs. These LGAs were selected to ensure geographical diversity, socio-economic representation, and variation in healthcare access, all of which are essential in assessing PID prevalence and its impact on reproductive and perimenopause women in Delta State

2.3 Study Population

The study population comprised women aged 20–55 years residing in the selected LGAs of Delta State. This age range is chosen to ensure adequate representation, as PID affects women of reproductive age, including perimenopause women who are the primary focus of this study.

2.4 Sample Size Determination

 For this study, the minimum number of sample required is computed in accordance with Cochran’s formula for sample size estimation: 

Where: 

= required sample size 

Z = standard normal deviation (1.96 for a 95% confidence level) 

p = Based on previous studies, let’s assume a conservative estimate of 50% (0.5) since it's the most statistically conservative and gives the maximum sample size.

q = 1 - p (0.80) 

e = margin of error (5% or 0.05) 

d = precision or margin of error (± 4.9% or 0.049).

Substituting the values: 

Thus, the final sample size is 400 respondents were selected to ensure adequate representation and statistical validity.

2.5 Sampling Technique

A multistage sampling technique was used to ensure a diverse and representative selection of respondents:

Stratified Sampling: Delta State was divided into senatorial districts, and four LGAs were selected to represent different geographical and socio-economic backgrounds.

Cluster Sampling: Each LGA was further divided into clusters (healthcare centers, markets, religious institutions, and community areas).

Systematic Random Sampling: Women within the selected clusters were randomly chosen using a sampling interval to ensure fairness.

Purposive Sampling: In healthcare centers, women diagnosed or treated for reproductive health issues were specifically targeted for inclusion.

This approach ensured representativeness, reduced bias, and enhanced the generalizability of the study findings. 

2.6 Data Collection Procedure

Data were collected using a structured questionnaire administered by the principal researcher and trained research assistants across selected community and healthcare settings. Participants were informed about the study objectives and confidentiality was assured. Informed consent was obtained before questionnaire administration. Each questionnaire required approximately 20–30 minutes to complete, and completed questionnaires were screened for completeness prior to analysis.

2.7 Instrument for Data Collection

Data were collected using a structured questionnaire consisting of six sections and 34 items aligned with the study objectives. The sections assessed socio-demographic characteristics, PID prevalence, symptom patterns, reproductive and STI history, awareness of PID, and health-seeking behaviours. The instrument was reviewed by public health and gynaecology experts and pilot-tested for clarity and relevance.

2.8 Validity of the Instrument

Instrument validity was ensured through expert review and pilot testing. Content validity was established by specialists in public health and gynaecology. Face validity was assessed through pilot testing among women similar to the target population. Construct validity was achieved by aligning questionnaire items with established theoretical and empirical literature on PID.

2.9 Reliability of the Instrument

Reliability was assessed through a pilot study involving 30 participants who were excluded from the main study. Internal consistency of questionnaire sections was evaluated using Cronbach’s alpha, with values of 0.7 or higher considered acceptable.

2.10 Method of Data Analysis

Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics including frequencies, percentages, means, and standard deviations were used to summarize respondent characteristics and study variables. Inferential analysis was performed using Chi-square tests to examine associations between PID occurrence and selected risk factors. Statistical significance was set at p < 0>

2.11 Inclusion and Exclusion Criteria

2.11.1 Inclusion Criteria

Women aged 20–55 years who were residents of the selected LGAs, capable of completing the questionnaire, and who provided informed consent were included.

2.11.2 Exclusion Criteria

Women who had undergone hysterectomy or salpingectomy, those who had reached menopause, those with unrelated chronic gynaecological conditions, or those unwilling or unable to participate were excluded.

2.12 Ethical Considerations

Ethical approval was obtained from the Institutional Research Ethics Committee of the Faculty of Basic Medical Sciences, Delta State University, Abraka (RBC/FBMC/DELSU/25/756). Participation was voluntary, and confidentiality of participant information was maintained.

3.1 Demographic Data of Respondents 

The demographic characteristics of the 400 participants presents a broad view of the population involved in the study. These include age, marital status, educational background, occupation, number of children, religion, menstrual status, and prior gynaecological history. The diversity in these variables enriches the analysis of PID in terms of exposure, awareness, and experiences. The age distribution is balanced, with the highest representation (25%) in the 45–49 group. This reflects a strong perimenopause presence. The even spread supports unbiased, age-based comparisons. Most respondents are in monogamous marriages (45%), followed by singles (20%) and polygamous (15%). Divorced/separated and widowed women (10?ch). This range supports insights into PID risks and health-seeking behaviour. Secondary education holders (40%) dominate, followed by tertiary (25%) and primary (20%). Only 10% had no formal education, while 5% had postgraduate degrees. The range allows analysis of education’s role in PID awareness and care. Trading (25%) and professional/civil service (20?ch) top the occupational list, while artisans and the unemployed follow (15?ch). The mix reflects varied socioeconomic backgrounds, affecting health access and PID exposure.

Most women have 3–4 children (40%), with 1–2 and 5+ children at 25?ch. Nulliparous women make up 10%. The data supports understanding how childbearing history relates to PID prevalence and complications. 

Menstrual Status: About 52.5% report irregular menstruation, while 47.5% menstruate once in a while. This split shows a blend of reproductive and post-reproductive women, enabling assessment of PID risk across menstrual health stages.

Table 1: Demographic Distribution of Respondents.

(Source: Computed from Author’s survey data, 2025)

3.2 Prevalence of PID

In order to assess the Prevalence of Pelvic Inflammatory Disease (PID) among reproductive and perimenopause women, participants were asked to respond to a series of statements addressing PID among reproductive and perimenopause women. The responses were measured using Yes/No. Diagnosis of PID: 60% of respondents reported having been diagnosed with PID (Mean = 1.60, SD = 0.49). This indicates a high prevalence and highlights the need for improved diagnostic access and awareness.

Persistent Pelvic Pain: 65% experienced persistent pelvic pain (Mean = 1.65, SD = 0.48), suggesting a strong link to possible undiagnosed or recurrent PID, especially among untreated individuals.

Abnormal Vaginal Discharge: Abnormal discharge was reported by 55% (Mean = 1.55, SD = 0.50), pointing to ongoing reproductive tract infections commonly associated with PID.

Hospital: Only 25% had been hospitalized (Mean = 1.25, SD = 0.43), implying that most PID cases remain non-severe or are managed outside hospital settings.

PID Treatment in the Past Two Years: 45% reported recent PID treatment (Mean = 1.45, SD = 0.50), indicating recurring infections and reinforcing the condition’s ongoing relevance. The prevalence of pelvic inflammatory disease among respondents is shown in Table 2.

Table 2: Prevalence of PID among Reproductive and Perimenopausal Women.

3.3 Symptoms Associated with PID 

In order to assess the Symptoms and Diagnosis of Pelvic Inflammatory Disease (PID), participants were asked to respond to a series of statements addressing symptoms of PID. The responses were measured using 4- Likert-type (Strongly Agree, Agree, Strongly Disagree, and Disagree). Irregular Menstruation: With a mean of 3.05, many relate PID to menstrual issues, supporting its diagnostic relevance.

Pain during Intercourse: Mean of 2.85 with 45.0% agreeing shows dyspareunia is prevalent and likely underreported.

Pelvic Pain: Mean of 2.90 shows that most respondents experience this common PID symptom, though with some variation (SD = 0.88).

Frequent or Painful Urination: With a mean of 2.60 (SD = 1.00), responses were more varied. 

Difficulty Conceiving: The lowest mean score (2.45, SD = 0.98) indicates moderate disagreement. The symptoms associated with pelvic inflammatory disease among respondents are presented in Table 3.

Table 3: Distribution of Respondents of Symptoms and Diagnosis of PID

(Source: Computed from Author’s survey data, 2025)

3.4 Reproductive History, STI History, and Contraceptive Use 

In order to assess the Reproductive History, STI History, and Contraceptive Use, participants were asked to respond to a series of statements addressing reproductive history. The responses were measured using Yes/No. Multiple Sexual Partners (Past 12 Months): 35% reported multiple partners (Mean = 1.35, SD = 0.48), indicating notable exposure to STIs. 

History of STIs: 40% had prior STI diagnoses (Mean = 1.40, SD = 0.49), supporting a strong link between STIs and PID. 

Use of Intrauterine Devices (IUDs): 30% reported IUD use (Mean = 1.30, SD = 0.46), warranting attention. 

History of Abortion: 45% had a history of abortion (Mean = 1.45, SD = 0.50), suggesting possible reproductive tract disruptions. Inadequate post-abortion care may increase PID risk.

History of Ectopic Pregnancy: 20% of respondents reported ectopic pregnancy (Mean = 1.20, SD = 0.40), the lowest among indicators. The distribution of respondents based on symptoms and diagnosis of PID is shown in Table 4.

Table 4: Distribution of Respondents by Reproductive History, STI History, and Contraceptive Use (N=400)

(Source: Computed from Author’s survey data, 2025)

In order to assess the Awareness and Knowledge of Pelvic Inflammatory Disease (PID), participants were asked to respond to a series of statements addressing awareness and knowledge of PID. The responses were measured using 4- Likert-type (Strongly Agree, Agree, Strongly Disagree, and Disagree). Awareness of PID: With a mean score of 3.40 (SD = 0.79), most respondents were aware of PID. 

3.5 Awareness and Knowledge of PID 

Knowledge of PID Symptoms: A mean of 3.30 (SD = 0.78) indicates good knowledge of key symptoms. 

Understanding of PID Complications: Respondents showed strong agreement (Mean = 3.35, SD = 0.78) that PID leads to serious outcomes. 

Knowledge of Treatment Access: A mean score of 3.30 (SD = 0.78) reflects awareness of where to access care. 

Regular check-ups: This item had the highest mean (3.50, SD = 0.71), indicating strong belief in check-ups for prevention. It reflects high preventive health literacy among the participants.

Table 5: Distribution of Respondents by Awareness and Knowledge of PID (N=400)

(Source: Computed from Author’s survey data, 2025)

3.6 Health-Seeking Behaviours and Preventive Practices 

In order to assess the health-Seeking Behaviours and Preventive Practices of Pelvic Inflammatory Disease (PID), participants were asked to respond to a series of statements addressing Health behaviour. The responses were measured using 5- Likert-type (Strongly Agree, Agree, Strongly Disagree, and Disagree). Seeking Care for Symptoms: Mean of 3.20 indicates moderate proactiveness, though a quarter avoid care.

Regular Gynaecology Check-ups: Yes (mean = 3.45) shows good preventive engagement.

Completing Antibiotics: Yes mean (3.62), reflecting strong adherence to treatment, a positive trend.

Safe Sex Practices: Mean of 3.52 suggests awareness is high but with scope for education.

Discussing PID with Professionals: Mean of 3.32 shows over half engage in discussions, but many still lack direct healthcare dialogue.

Table 6: Health-Seeking Behaviours and Preventive Practices

(Source: Computed from Author’s survey data, 2025)

3.8 Test Of Significance

Inferential statistics were used, including Chi-square tests for associations, T-tests for comparing group means, One-Way ANOVA for differences across educational levels, and Logistic Regression to predict PID awareness and prevalence based on factors like marital status and gynaecological history. Hypothesis testing determined whether observed differences were statistically meaningful, using a 95% confidence level (α = 0.05). A p-value < 0>

In table 7, the study tested whether there is a significant difference in the prevalence of Pelvic Inflammatory Disease (PID) between reproductive and perimenopause women. With equal sample sizes of 200, the observed PID rates were 45% for reproductive women and 75% for perimenopausal women. A Z-test yielded a statistic of -6.12 and a p-value less than 0.001. Since the p-value is well below the 0.05 significance level, the null hypothesis was rejected. This indicates a statistically significant difference in PID prevalence, with perimenopause women showing a higher rate than reproductive women.

Table 7: Comparison of PID Prevalence between Reproductive and Perimenopause Women

(Source: Computed from Author’s survey data, 2025)

Table 8: Association between Reported Symptoms and PID Diagnosis

(Source: Computed from Author’s survey data, 2025)

Table 8 shows independent samples t-test results assessing the association between core PID symptoms and PID diagnosis. All five symptoms had t-values between 11.22 and 16.31, with p-values < 0.001, indicating significant differences.

Table 9: Risk Factor Association

 (Source: Computed from Author’s survey data, 2025)

Table 10 presents t-test results on five PID risk factors using binary-coded responses. All variables showed significant differences between women with and without PID (t-values: 2.75–7.89, p < 0.01). Women with histories of multiple partners, STIs, IUD use, abortion, or ectopic pregnancy were significantly more likely to have PID, confirming strong associations with these risk factors 

Table 10: Awareness Level of PID

(Source: Computed from Author’s survey data, 2025)

Table 10 presents the results of independent samples t-tests comparing PID awareness levels between reproductive-aged and perimenopause women across five key awareness items. In each case, reproductive-aged women showed significantly higher awareness, with mean scores ranging from 3.5 to 3.7, compared to 3.1 to 3.3 for perimenopause women. All t-values range from 3.88 to 4.37, and p-values are all less than 0.001, indicating strong statistical significance. 

Table 11: Type of Marriage and PID Prevalence

(Source: Computed from Author’s survey data, 2025)

Table 11 shows the Chi-square test which yields a calculated value of 12.35, at df = 1 and α = 0.05. This result is statistically significant (p > 0.0004), leading to rejection in the null hypothesis. This suggests that marital structure may influence sexual health risks, possibly due to increased exposure to multiple sexual partners or reduced autonomy in reproductive and perimenopause. 

Table 12: Health-Seeking Behavior

(Source: Computed from Author’s survey data, 2025)

Table 12 presents Independent Samples T-Test results assessing the association between health-seeking behaviours and PID diagnosis among reproductive and perimenopause women. All five behaviours showed statistically significant differences (p< 0.05), with higher mean scores reported by women without PID. This indicates that positive health-seeking practices are associated with lower PID prevalence. Therefore, the null hypothesis is rejected, confirming a significant relationship between health-seeking behaviour and PID diagnosis. 

Figure 1: PID Prevalence between Reproductive and Perimenopause Women

Figure 2: Symptoms and PID Diagnosis

Data were expressed as Mean ± SD, ****p<0.0001 is significant in all groups.

Figure 3: Risk Factor Association

Data were expressed as Mean ± SD, ****p<0.0001 is significant in all groups.

Figure 4: Awareness Level of PID

Data were expressed as Mean ± SD, ****p<0.0001 is significant in all groups.

Figure 5: Type of Marriage and PID Prevalence

Figure 6: Health-Seeking Behaviour

Data were expressed as Mean ± SD, ****p<0.0001 is significant in all groups.

This study examined the prevalence, associated symptoms, risk factors, awareness, marital structure, and health-seeking behaviours related to pelvic inflammatory disease (PID) among reproductive and perimenopausal women. The findings revealed a significantly higher prevalence of PID among perimenopausal women (75%) compared with reproductive-aged women (45%), confirming a greater disease burden in older women. This observation supports earlier findings that identified PID as a persistent reproductive health problem among Nigerian women and globally [14,35,1]. The higher prevalence among perimenopausal women may reflect cumulative lifetime exposure to sexually transmitted infections (STIs), hormonal changes, and declining immune responses, as previously reported [33].

Strong associations were observed between PID and core clinical symptoms, including irregular menstruation, dyspareunia, pelvic pain, frequent urination, and difficulty conceiving. These findings highlight the importance of symptom recognition in PID diagnosis, particularly in resource-limited settings where laboratory confirmation may be limited. Similar symptom patterns have been documented in previous studies, which emphasise that delayed recognition and treatment may result in infertility and chronic pelvic pain [27,36,37].

Sexual and reproductive history significantly influenced PID occurrence. Women with previous STIs, multiple sexual partners, abortion history, intrauterine device (IUD) use, and ectopic pregnancy showed significantly higher PID prevalence. These findings are consistent with earlier reports identifying STIs, particularly Chlamydia trachomatis and Neisseria gonorrhoeae, as primary etiological agents of PID [2,4,8]. IUD use has also been linked to PID when insertion occurs in the presence of untreated cervical infections [17]. Additionally, sexual risk behaviours and reproductive tract trauma associated with abortion or ectopic pregnancy may increase susceptibility to ascending infections [16].

An important observation was the relationship between PID diagnosis and awareness. Women diagnosed with PID demonstrated significantly higher awareness levels than those without prior diagnosis, suggesting that awareness often follows clinical exposure rather than serving as a preventive factor. Similar findings have been reported, indicating that healthcare interaction improves disease knowledge and preventive practices [19,38]. This underscores the need for proactive public health education targeting undiagnosed women, as recommended in previous reproductive health studies [1,31].

Marital structure was also significantly associated with PID prevalence. Women in polygamous marriages demonstrated nearly threefold higher odds of PID compared with those in monogamous unions. This finding supports earlier evidence that expanded sexual networks and reduced autonomy in reproductive health decision-making may increase STI exposure in polygamous settings [33]. Such sociocultural factors highlight the importance of culturally sensitive reproductive health interventions in sub-Saharan Africa.

Health-seeking behaviour emerged as a protective factor against PID. Women who reported early medical consultation, routine gynaecological check-ups, completion of antibiotic treatment, safe sexual practices, and communication with healthcare providers showed significantly lower PID prevalence. These findings align with previous research demonstrating that early diagnosis, treatment adherence, and regular clinical monitoring reduce PID complications, including infertility, tubo-ovarian abscess, and chronic pelvic pain [28,39,19].

The findings of this study also align with global evidence identifying PID as a major contributor to infertility and chronic reproductive morbidity worldwide [13]. Associations between PID and adverse reproductive outcomes, including ectopic pregnancy and chronic pelvic pain, have been consistently reported [32,31]. Emerging research further suggests that hormonal changes and alterations in vaginal microbiota during the perimenopausal transition may increase susceptibility to infection, supporting the need for age-specific screening and preventive strategies [10,9].

Overall, this study highlights the multifactorial nature of PID among reproductive and perimenopausal women, emphasizing the combined influence of biological, behavioural, and sociocultural determinants. Addressing these factors through targeted education, improved healthcare access, and age-specific screening strategies is essential for reducing PID-related morbidity and improving reproductive health outcomes.

This study found a high prevalence (75%) of Pelvic Inflammatory Disease (PID) among reproductive and perimenopausal women, highlighting an often-overlooked public health concern. The persistence of PID in aging women is linked to cumulative reproductive exposures, age-related changes, and risk factors such as prior STIs, IUD use, multiple partners, abortion history, and polygamous unions. Common symptoms pelvic pain, vaginal discharge, and dyspareunia proved reliable for diagnosis, especially in low-resource settings. Although awareness was higher among diagnosed women, it followed rather than prevented illness, underscoring the need for proactive education. Improved outcomes were associated with timely care-seeking, regular check-ups, and treatment adherence, pointing to the need for integrated strategies combining education, early screening, and culturally sensitive interventions.

Based on the study's findings, the following recommendations are proposed:

1. Intensify public awareness campaigns on PID symptoms, risks, and prevention, especially targeting perimenopausal women through community outreach and media.
2. Integrate PID screening into regular reproductive health check-ups to enable early detection and treatment.
3. Enhance access to affordable, quality healthcare services, particularly in rural areas, through subsidized treatments and mobile clinics.
4. Train health workers to recognize and manage PID in older women, avoiding misdiagnosis related to menopause.
5. Encourage condom use and partner involvement in prevention and treatment to reduce reinfection.

From a clinical standpoint, this study underscores the urgent need for targeted screening and diagnostic strategies for PID in both perimenopausal and reproductive-age women. This population is often overlooked in routine gynaecological care, with symptoms mistakenly attributed to menopausal transition or aging. Clinicians should maintain a high index of suspicion for PID in women presenting with pelvic pain, abnormal discharge, or menstrual irregularities, particularly when there is a history of STIs, intrauterine device use, or polygamous unions. Integrating PID-specific screening algorithms into regular gynaecologic evaluations and strengthening provider training on symptom recognition and age-specific risk factors will enhance early detection and treatment outcomes. At the public health level, education campaigns are essential to dispel misconceptions about PID, encourage prompt medical consultation, and promote STI screening and treatment adherence. Such measures will help prevent long-term complications, including infertility, chronic pelvic pain, and ectopic pregnancy, thereby improving women’s reproductive health across all age groups.

The authors wish to declare that there are no potential conflicts of interest that could partially or fully prejudice the research report.