Laparoscopic findings in women with clinical signs and symtpoms of pelvic inflammatory disease were correlated with contraceptive use in a case-control study. Of the 738 women, 544 (73.7%) had laparoscopic signs of acute salpingitis, 194 (26.3%) had visually normal fallopian tubes (nonsalpingitis). Acute salpingitis was seen in 59.8% of the 286 patients using oral contraceptives, in 80.6% of the 227 patients using an inrauterine device (IUD) and in 84.4% of the 225 patients using barrier methods or not using contraceptives (reference group). To estimate the relative risk of acute salpingitis, logistic regression analysis adjusting for age and duration of pain before laparoscopy was used. For oral contraceptive users vs. the reference group the adjusted relative risk was estimated at 0.24 (95% confidence interval 0.15-0.38, P < 0.0001); for IUD users vs. the reference group a relative risk was estimated at 0.83 (95% confidence interval 0.49 to 1.38, P = .46). The relative risk of salpingitis among oral contraceptive users vs. the reference group was 0.22 (P = 0.005), and 0.06 (P = 0.001) for women infected with Chlamydia trachomatis and/or Neisseria gonorrhoeae, respectively. In patients with pelvic inflammatory disease, spread of the inflammation to the fallopian tubes seems to be inhibited in oral contraceptive users.