THE womb is a pear-shaped organ where a baby is carried during pregnancy.
While you might not know it, you could be one of the many women who has a tilted version.
Also known as a “retroverted” uterus, this is when the organ tilts backward toward the spine, and may make sex uncomfortable.
The condition affects between 20 and 25 per cent of people with a uterus, statistics say, but many show no symptoms.
And while for most it doesn’t cause any issues, for others it can lead to problems with sex, pregnancy and more.
Usually the uterus, which is fist-sized and holds an unborn baby, sits upright or sometimes slightly forward.
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A retroverted uterus tilts backward toward the spine.
Anne Henderson, Consultant Gynaecologist and British Menopause Society Accredited Specialist, said: “It’s not unusual.
“For the vast majority of women, if they are told during a smear test or when they have an examination they are retroverted, that's just part and parcel of their anatomy and doesn't imply anything is wrong.
“Where you have a tilted or retroverted uterus which is associated with pain, particularly pain with examination, during a smear, intercoruse or period, that's slightly more related to pathology.”
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Anne explained that some women are born with a retroverted uterus, others develop it due to disease (pathology) that may need attention.
The most common cause is the agonising condition endometriosis, because the scar tissue behind the womb pulls it backwards.
Untreated pelvic inflammatory disease (PID), an infection that can be the result of an STI, can also cause scarring that tugs the womb back.
When you have a tilted or retroverted uterus which is associated with pain, that's slightly more related to pathology.
Fibroids – benign growth of tissueare also a cause, and the menopause can weaken the ligaments that hold the uterus in the correct place.
“Women need to be aware that if there is a change, they may need to get that checked out,” Anne said.
“Generally it's reassuring that only a minority of women need to see a GP or potentially a gynaecologist.”
While normally women find out they have a retroverted uterus during a routine examination or smear test, they may first find out when pregnant.
In many cases there is no need to treat the condition.
If it causes a lot of problems, there are options including exercises and devices that manipulate the uterus to go back into the correct position.
What are the signs and when should I see a doctor?
Sometimes there are no symptoms of a retroverted uterus.
Other times it can cause the following, which may suggest there is an underlying cause and you should see a doctor:
- Pain in your vagina or lower back during sex
- Pain during your period
- Trouble inserting tampons or discomfort
- Increased urinary frequency or feelings of pressure in the bladder
- Repeated urinary tract infections (UTIs)
- Mild incontinence
- Protrusion of the lower abdomen
What are the risks?
“Generally speaking, a retroverted uterus should not cause any major problems,” says Heli Kurjanen, a “menstrual expert” and founder of Lunette Menstrual Cup.
But it can make sex unconfromable and even painful.
Heli said: “Usually with a retroverted uterus, the ovaries and fallopian tubes also lean backwards, meaning they can be ‘butted’ by the penis during intercourse.
“This is known as ‘collision dyspareunia’, and usually causes the most pain when you are on top. Vigorous sex in this position can potentially injure or tear the ligaments surrounding the uterus.
“If you have discomfort during sex, try changing positions. If all sexual positions cause pain, with or without bleeding, discuss this with your doctor.”
While a tilted womb doesn’t prevent pregnancy, it may contribute to miscarraige risk, Helo said.
“In a small percentage of cases, the growing uterus can snag on the pelvic bone, which causes an uncommon condition called an ‘incarcerated uterus’, which can mean that the risk of miscarriage increases.
“The symptoms include pain and difficulty urinating, and will usually occur between weeks 12 and 14.
“When discovered early, an incarcerated uterus can be fixed, reducing or eliminating miscarriage risk.”
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An retroverted uterus can also put pressure on the bladder during pregnancy, causing incontinence, difficulty urinating and back pain.
“Your third trimester should not be affected at all. Some people with a retroverted uterus are more likely to experience labour pain in the back,” Heli said.
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