Understanding the retroverted uterus

WHETHER it’s termed a tipped, tilted or retroverted uterus, the condition results in a woman’s uterus being tipped backward at the cervix instead of forward, and it can sometimes, though seldom, cause issues for women, especially when it’s secondary to other conditions like endometriosis.

Many women find out they have the problem on ultrasound for a pregnancy, where it’s seen that the top of the uterus is angled toward the woman’s back instead of the abdominal wall. It’s seen in as much as 15 per cent of normal women, doctors say, but does not cause any problems with conception.

Causes

•In some cases, the uterus becomes tilted because it becomes bound down by adhesions from pelvic infection or endometriosis. In these situations, this may be associated with severe painful intercourse and there may be problems with infertility. In endometriosis, the woman would have deposits holding the uterus in a retroverted position and the tubes are affected. The woman may also have some amount of discomfort with intercourse involving deep penetration or violent thrusting.

• As a woman matures the uterus may not move into a forward position, according to the American Pregnancy Association.

• Childbirth can also tip the uterus forward or backward. If the ligaments holding the uterus in place stretch, or lose their tension during pregnancy, it can become tipped. In most cases, the uterus returns to a forward position after childbirth.

Diagnosis

A tilted uterus is usually diagnosed during a routine pelvic examination. It usually does not pose any medical problems, though it can be associated with dyspareunia (pain during sexual intercourse) and dysmenorrhoea (painful periods). Secondary to or compounded by other conditions such as endometriosis or Pelvic Inflammatory Disease, the tilted uterus can result in painful sex.

A woman who has a tilted uterus can still become pregnant as it has no effect on fertility.

Symptoms

Some women do not experience any symptoms. However, others may experience back pain during sexual intercourse, pain during menstruation, minor incontinence, urinary tract infections or difficulty using tampons.

Treatment

A tipped uterus will usually right itself during the 10th to 12th week of pregnancy. Rarely, a tipped uterus will cause painful and difficult urination, and can cause severe urinary retention.

Treatment can include manual anteversion of the uterus, and usually requires intermittent or continuous catheter drainage of the bladder until the problem is rectified, or resolved spontaneously. It resolves by the natural enlargement of the uterus, which brings it out of the tipped position.