Retroverted uterus

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Retroverted uterus
Other namesTipped uterus
Retroverted uterus in pregnancy.png
A transvaginal ultrasound showing a retroverted uterus during pregnancy. The cervix lies posteriorly to the urinary bladder, and the uterus normally extends superiorly from it, but the direction of the body of the fetus reveals that the uterus extends backwards.
Specialty Gynaecology
TreatmentExercise. Vaginal pessary. Manual repositioning. Surgery.

A retroverted uterus (tilted uterus, tipped uterus) is a uterus 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, with the anterior part slightly concave. Between one in three to one in five uteruses is retroverted, or oriented backwards towards the spine. 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.

Contents

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:

Left: Anteverted, the most common position; Middle: Retroverted; Right: Retroflexed Retroverted and Retroflexed Uterus 1.png
Left: Anteverted, the most common position; Middle: Retroverted; Right: Retroflexed
DistinctionMore commonLess common
Position overall"anteverted": oriented forward"retroverted": oriented backwards
Position of fundus"anteflexed": the fundus (deepest part of uterus) is pointing forward relative to the cervix. Anterior aspect of uterus is concave."retroflexed": the fundus is pointing backwards. Anterior aspect of uterus is convex.

Additional terms include:

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. [1]

Some other conditions and gynaecological diseases can cause a retroverted uterus. [2] Endometriosis can cause the retroversion by 'gluing' the uterus to other pelvic structures or attach itself to other organs. Uterine fibroids can cause the uterus to tip backwards.

Pregnancy 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 equally affect these ligaments - when menstrual cycles stop, estrogen hormone 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. [3]

Diagnosis

A retroverted uterus is usually noted during a routine pelvic examination or with an internal ultrasound. [4]

It usually does not pose any medical problems, though it can be associated with dyspareunia (pain during sexual intercourse) and dysmenorrhea (pain during menstruation). [5]

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. [6] A tipped uterus will usually move to the middle of the pelvis during the 10th to 12th week of pregnancy.

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. [7]

In addition to manual anteversion and bladder drainage, treatment of urinary retention due to a retroverted uterus can require the use of a pessary, 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 and the fallopian tubes are also tilted, and dyspareunia can occur, [8] 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. [9]

Treatment

Treatment options are rarely needed, but if they cause problems some options for a solution can be offered. [10]

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 - which is a small plastic or silicone device can be placed either temporarily or permanently to prop the uterus forward. Pessaries are linked with increased risk of infection and inflammation and may cause discomfort during intercourse.

Using laparoscopic (‘keyhole’) surgery techniques, a doctor can reposition the uterus so that it sits over the bladder - the procedure is relatively straightforward and usually successful. In some instances, a hysterectomy (the surgical removal of the uterus) may be considered.

Related Research Articles

<span class="mw-page-title-main">Uterus</span> Female sex organ in mammals

The uterus 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 fertilized eggs until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

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 female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

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 (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.

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 location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.

<span class="mw-page-title-main">Pelvic floor</span> Anatomical structure

The pelvic floor or pelvic diaphragm is an anatomical location in the human body, which has an important role in urinary and anal continence, sexual function and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and smooth, ligaments and fascia. and separates between the pelvic cavity from above, and the perineum from below. It is formed by the levator ani muscle and coccygeus muscle, and associated connective tissue.

<span class="mw-page-title-main">Pelvic floor dysfunction</span> Medical condition

Pelvic floor dysfunction is a term used for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. The condition affects up to 50 percent of women who have given birth. Although this condition predominantly affects women, up to 16 percent of men are affected as well. Symptoms can include pelvic pain, pressure, pain during sex, urinary incontinence (UI), overactive bladder, bowel incontinence, incomplete emptying of feces, constipation, myofascial pelvic pain and pelvic organ prolapse. When pelvic organ prolapse occurs, there may be visible organ protrusion or a lump felt in the vagina or anus. Research carried out in the UK has shown that symptoms can restrict everyday life for women. However, many people found it difficult to talk about it and to seek care, as they experienced embarrassment and stigma.

<span class="mw-page-title-main">Adenomyosis</span> Extension of endometrial tissue into the myometrium

Adenomyosis is a medical condition characterized by the growth of cells that proliferate on the inside of the uterus (endometrium) atypically located among the cells of the uterine wall (myometrium), as a result, thickening of the uterus occurs. As well as being misplaced in patients with this condition, endometrial tissue is completely functional. The tissue thickens, sheds and bleeds during every menstrual cycle.

<span class="mw-page-title-main">Cystocele</span> Protrusion of the bladder into the vagina

The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.

<span class="mw-page-title-main">Pelvic pain</span> Medical condition

Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both the male and female pelvis.

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

Ovarian diseases refer to diseases or disorders of the ovary.

Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

Subinvolution is a medical condition in which after childbirth, the uterus does not return to its normal size.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

Round ligament pain (RLP) is pain associated with the round ligament of the uterus, usually during pregnancy. RLP is one of the most common discomforts of pregnancy and usually starts at the second trimester of gestation and continues until delivery. It usually resolves completely after delivery although cases of postpartum RLP have been reported. RLP also occurs in nonpregnant women.

<span class="mw-page-title-main">Uterine incarceration</span> Medical condition

Uterine incarceration is an obstetrical complication whereby a growing retroverted uterus becomes wedged into the pelvis after the first trimester of pregnancy.

Frozen pelvis is a severe complication of other medical conditions, especially endometriosis and cancer.

Pelvic floor physical therapy (PFPT) is a specialty area within physical therapy focusing on the rehabilitation of muscles in the pelvic floor after injury or dysfunction. It can be used to address issues such as muscle weakness or tightness post childbirth, dyspareunia, vaginismus, vulvodynia, constipation, fecal or urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Licensed physical therapists with specialized pelvic floor physical therapy training address dysfunction in individuals across the gender and sex spectra, though PFPT is often associated with women's health for its heavy focus on addressing issues of pelvic trauma after childbirth.

References

  1. Services, Department of Health & Human. "Retroverted uterus". www.betterhealth.vic.gov.au. Retrieved 2023-11-22.
  2. "Retroverted Uterus" Women's Health, 2009, Web. 5 Mar. 2010. <http://www.womens-health.co.uk/retrover.asp>
  3. "What is a Tilted Uterus" International Society for Sexual Medicine, 9 May. 2021.<https://www.issm.info/sexual-health-qa/what-is-a-tilted-uterus-how-might-it-affect-a-woman-sexually/>
  4. "Retroversion of the uterus Information | Mount Sinai - New York".
  5. "What is a tilted uterus how might it affect a woman sexually? - ISSM". 26 August 2014.
  6. "Tilted uterus: Can it lead to infertility? - Mayo Clinic". Mayo Clinic .
  7. Anatomic and Functional Changes of the Lower Urinary Tract During Pregnancy. Urologic Clinics of North America - Volume 34, Issue 1 (February 2007)
  8. "Dyspareunia (Painful Intercourse): Causes, Diagnosis & Treatment". Cleveland Clinic. Retrieved 2023-11-22.
  9. Services, Department of Health & Human. "Retroverted uterus". www.betterhealth.vic.gov.au. Retrieved 2023-11-22.
  10. Services, Department of Health & Human. "Retroverted uterus". www.betterhealth.vic.gov.au. Retrieved 2023-11-22.