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A retroverted uterus (tilted uterus, tipped uterus) is a
uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
that is oriented posteriorly, towards the back of the body. This is in contrast to the typical uterus, which is oriented forward (slightly " anteverted") toward the
bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine en ...
, with the anterior part slightly concave. Depending on the source, one in three to five uteruses is retroverted, or oriented backwards towards the
spine Spine or spinal may refer to: Science Biology * Vertebral 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 (zoolo ...
.


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: 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. There are other factors, however, that can cause the uterus to become retroverted. Pelvic surgery, pelvic adhesions,
endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, fa ...
, fibroids,
pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be ...
, or the labor of
childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glob ...
can change the position of the uterus to retroverted."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 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 medical 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 ...
(pain during
sexual intercourse Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal pene ...
) 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).


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 develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...
. 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.Anatomic and Functional Changes of the Lower Urinary Tract During Pregnancy. Urologic Clinics of North America - Volume 34, Issue 1 (February 2007) 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 vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the locati ...
, or even surgery. If a uterus does not reposition, it may be labeled ''persistent''.


Treatment

Treatment options are rarely needed, and include exercises, a
pessary A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the locati ...
, manual repositioning, and surgery.


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