A retroverted uterus (tilted uterus, tipped uterus) is a

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

that is oriented posteriorly, towards the rectum in the back of the body. This is in contrast to the typical uterus, which is oriented forward (slightly " anteverted") toward the

bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distens ...

, with the anterior part slightly concave. Between one in three to one in five uteruses is retroverted, or oriented backwards towards the

spine Spine or spinal may refer to: Science Biology * Spinal column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoology), ...

. Generally, a retroverted uterus does not cause any problems, nor does it interfere with pregnancy or fertility. Most people with retroverted uteruses will not know they have this characteristic.

Related terms

The following table distinguishes among some of the terms used for the position of the uterus: A retroverted uterus should be distinguished from the following: Retroverted and Retroflexed Uterus 1

Additional terms include: * ''retrocessed uterus:'' both the superior and inferior ends of the uterus are pushed posteriorly * ''severely anteflexed uterus:'' a pronounced forward bend in an anteflexed uterus * ''vertical uterus:'' the fundus (top of the uterus) is straight up

Causes

In most cases, a retroverted uterus is a normal variation present from birth. As a woman matures, the uterus generally moves into a forward tilt, however in some cases the uterus remains in the same position angled backwards. Some other conditions and gynaecological diseases can cause a retroverted uterus.

Endometriosis Endometriosis is a disease in which Tissue (biology), tissue similar to the endometrium, the lining of the uterus, grows in other places in the body, outside the uterus. It occurs in women and a limited number of other female mammals. Endomet ...

can cause the retroversion by 'gluing' the uterus to other pelvic structures or attach itself to other organs.

Uterine fibroids Uterine fibroids, also known as uterine leiomyomas, fibromyoma or fibroids, are leiomyoma, benign smooth muscle tumors of the uterus, part of the female reproductive system. Most people with fibroids have no symptoms while others may have dysm ...

can cause the uterus to tip backwards.

Pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

can sometimes overstretch the ligaments that hold the uterus in place and allow it to tip backwards, however it does tend to return to its original shape.

Menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...

equally affect these ligaments - when menstrual cycles stop,

estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...

hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...

levels decline and impact the surrounding uterine ligaments. Pelvic adhesions (scar tissue) can be caused by surgery in the pelvic area which can pull the uterus into a retroverted position."What is a Tilted Uterus" ''International Society for Sexual Medicine'', 9 May. 2021.

Diagnosis

A retroverted uterus is usually noted during a routine

pelvic examination A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, ...

or with an internal ultrasound. It usually does not pose any medical problems, though it can be associated with

dyspareunia Dyspareunia ( ) is painful sexual intercourse due to somatic or psychological causes. The term ''dyspareunia'' covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the f ...

(pain during

sexual intercourse Sexual intercourse (also coitus or copulation) is a sexual activity typically involving the insertion of the Erection, erect male Human penis, penis inside the female vagina and followed by Pelvic thrust, thrusting motions for sexual pleasure ...

) and

dysmenorrhea Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in th ...

(pain during

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...

Fertility and pregnancy

Rarely, a retroverted uterus is due to a disease such as endometriosis, an infection or prior surgery. Those conditions, but not the position of the uterus itself, can reduce fertility in some cases. A tipped uterus will usually move to the middle of the pelvis during the 10th to 12th week of

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

. Rarely (1 in 3,000 to 8,000 pregnancies), a retroverted uterus will cause painful and difficult urination and can cause severe urinary retention. Treatment for this condition (called " incarcerated uterus") includes manual anteversion of the uterus, and usually requires intermittent or continuous catheter drainage of the bladder until the problem is rectified or spontaneously resolves by the natural enlargement of the uterus, which brings it out of the tipped position. In addition to manual anteversion and bladder drainage, treatment of urinary retention due to a retroverted uterus can require the use of a

pessary A pessary is a prosthetic device inserted into the Human vagina, vagina for structural and pharmaceutical purposes. It is most commonly used to treat Stress incontinence, stress urinary incontinence to stop urinary leakage and to treat pelvic org ...

, or even surgery. If a uterus does not reposition, it may be labeled ''persistent''.

Sexual impact

Most people will not know that they have a retroverted uterus, however it can sometimes affect sexual intercourse. Considering the angle of the uterus, the

ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...

and the

fallopian tubes The fallopian tubes, also known as uterine tubes, oviducts or salpinges (: salpinx), are paired tubular sex organs in the human female body that stretch from the ovaries to the uterus. The fallopian tubes are part of the female reproductive sy ...

are also tilted, and

can occur, where the head of the penis may impact or butt these parts during intercourse. Being positioned on top can be more painful. Vigorous sex can sometimes cause ligaments in or around the uterus to tear or be injured.

Treatment

Treatment options are rarely needed, but if they cause problems some options for a solution can be offered. A doctor can manually reposition the uterus in a pelvic examination if movement of the uterus is not hindered by endometriosis or fibroids, and exercises afterwards may help. Doctors are divided as to whether or not pelvic exercises are worthwhile as a long term solution, as in many cases the uterus tips backwards again. If the retroverted uterus is caused by underlying conditions like endometriosis, hormone therapy can be offered. A pessary—a small plastic or silicone device—supports the uterus in a forward position either temporarily or permanently. However, pessaries correlate with higher

infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

and

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

risks, and patients may experience discomfort during intercourse. Through

laparoscopic Laparoscopy () is an operation performed in the abdomen or human pelvis, pelvis using small Surgical incision, incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few ...

("keyhole") surgery,

surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...

s can reposition the uterus over the bladder. This minimally invasive procedure typically yields successful results. In some cases, healthcare providers may recommend a

hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes ( salpi ...

(surgical removal of the uterus).

References

External links

*
Overview at mayoclinic.com

Diagram at womens-health.co.uk
{{Diseases of the pelvis, genitals and breasts Noninflammatory disorders of female genital tract