Tilted, slanted or tipped: What is a retroverted uterus?
A tilted uterus is more common than you might have thought
TL/DR: One in five people with vaginas have what’s known as a tilted, or retroverted, uterus. Instead of pointing forward toward the belly button, a retroverted uterus points in the opposite direction, towards the lower back.
All kinds of images come to mind when you hear the words ‘tilted,’ ‘slanted,’ or ‘tipped’. A spilled drink, perhaps a bookshelf that was installed incorrectly, or maybe an off-center picture frame? No big deal, right? When used to describe the uterus, however, those three words can lead to panic.
Well, we’re here to tell you not to panic. A tilted, A.K.A. retroverted uterus is a common anatomical anomaly (how’s that for a tongue twister?). It is seen in approximately one in five individuals assigned female at birth. (2020, March 31). U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/001506.htm))
Typically, the uterus points forward toward the belly button. When the uterus is tilted or retroverted, it points backwards and down towards the lower back, instead.1 Additionally from being retroverted (pointing backwards), some uterus-havers can experience a retroflexed uterus when it is also bent backwards.
A tilted or retroverted uterus doesn’t always cause symptoms. For those who do experience symptoms, they’re usually easy enough to manage with simple lifestyle changes.
Here’s the lowdown on retroverted uteruses:
Signs & symptoms of a retroverted uterus
Only some individuals with a tipped uterus or with uterine retroflexion experience symptoms. They may include:
- Vaginal, pelvic, or lower back pain during sexual intercourse,
- Painful periods, a.k.a. dysmenorrhea,
- Slight urinary incontinence, and
- Feeling of pressure on the bladder.2
If you’re noticing any of these signs or symptoms, make sure to talk to your doctor or OB-GYN. If you’re diagnosed with a retroverted uterus, it’s no big deal. Your doctor will be able to offer treatment options and recommendations on managing any discomfort. In extreme cases, the doctor might recommend surgery to reposition the uterus.
However, it’s important to rule out other potential causes for painful periods, urinary issues, or pain during sex.
What causes a retroverted uterus?
Some individuals are born with a retroverted uterus – in these cases, it’s just a roll of the genetic dice. Others may experience uterine retroversion after menopause or following childbirth, due to loosening of the ligaments that hold the uterus upright.
In some cases, uterine scar tissue from conditions or procedures can pull the uterus backward, leading to retroversion. These could include endometriosis, pelvic surgeries and uterine fibroids. Tumors, and/or infections of the uterus or fallopian tubes such as pelvic inflammatory disease are also included.3
Retroverted Uterus and Pregnancy
In addition, pregnancy itself can lead to uterine retroversion. It’s normal for the position of the uterus to change intermittently throughout gestation. A retroverted uterus is seen in 10-20% of pregnancies during the first trimester.4
A tilted uterus in pregnancy is usually temporary and only causes problems in extremely rare cases. One of these extremely rare conditions is called incarcerated uterus. It occurs when the pregnant retroverted or retroflexed uterus grows and becomes wedged into the pelvis.
How is a retroverted uterus diagnosed?
Routine pelvic exams are a great start to discard many issues your vagina might have. However, your doctor or OB-GYN will request a transvaginal ultrasound in order to diagnose a retroverted or tilted uterus.5
During the ultrasound, your doctor or a technician will insert a wand into your vaginal canal. In order to obtain a clear view of where your uterus sits, your bladder needs to be emptied before the procedure. The ultrasound only takes a couple of minutes and you’ll likely find out the results right away.
Sex, pregnancy & fertility with a retroverted uterus
In the past, doctors thought that a tilted uterus might lead to infertility. However, it turns out that sperm can navigate fertile uterine roads of all shapes and sizes. Recent studies have shown that a tilted or retroverted uterus doesn’t have any impact on fertility.6
In less common cases, scar tissue can cause a sharp tilt in the uterus. Scar tissue in the uterus can be caused by conditions like endometriosis, infections, or prior surgeries. This may make it more challenging for sperm to reach and fertilize an egg.6 If you have any concerns about your ability to conceive, talk to your OB-GYN.
In terms of your sex life, a retroverted uterus may not create any problems whatsoever. For those who do notice pain or discomfort during intercourse, experiment with new positions until you find what works for you.
Why do some people with tilted uteruses deal with painful sex while others don’t? It’s because every tilt is different. A tipped uterus may change the angle at which the vagina meets the cervix. It can also change the orientation of the pelvic floor muscles.7
For some, positions in which the pelvic floor muscles are getting a ton of repeated pressure don’t feel so great.
Tip: Many individuals with a retroverted uterus find penetrative sex to be most comfortable when face-to-face with their partner. A “cross-wise” position is also a viable option. 78
How a retroverted uterus could impact your period
Want to find out how a tilted uterus could affect your period? Dr. Jane van Dis, a board certified OB-GYN with 13 years of experience tells us all about it.
“Individuals who have a retroverted uterus often complain of more painful periods,” she explains. “Some might find Flex Disc™ more comfortable [than other menstrual products] because the Disc sits at the top of the vagina — the widest portion of the vagina — thus limiting the amount of pressure on vaginal walls.” Since the orientation of your pelvic floor muscles might differ with a retroverted uterus, less vaginal pressure usually = less discomfort.
It’s true: Dysmenorrhea (intense period pain) is more common in those with a retroverted uterus.3 It’s thought that the body has to cramp a little bit harder to push out menstrual blood. The angle of retroversion may explain to some extent, how much pain is experienced.
One study found that higher period pain intensity was associated with more extreme angles of uterine flexion (i.e. tilt), regardless of whether that tilt was pointed forwards or backwards.9
If you’re experiencing severely painful periods, don’t immediately jump to conclusions and assume you have a retroverted uterus. Dysmenorrhea has many possible causes: Talk to your doctor or OB-GYN to rule out other conditions.
One in five people have a tilted uterus: It’s totally common and isn’t considered a medical problem. While some people don’t feel any symptoms, others experience more painful periods, bladder pressure or discomfort, and/or painful sex. For some, a retroverted uterus can also make tampons pretty uncomfortable.
If you’ve been diagnosed with a retroverted uterus, talk to your doctor first to find ways to manage your symptoms. There are a number of groups and forums online dedicated to discussing tilted uteruses that may be helpful, as well. Talk to your partner about finding sex positions that are comfortable and pleasurable for both of you. You can also experiment with different menstrual products to manage your period.
At the end of the day, the most important thing to remember is to listen to your body. If you’re experiencing pain, don’t ignore it – seek professional advice ASAP.
This article is informational only and is not offered as medical advice, nor does it substitute for a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician.
© 2021 The Flex Company. All Rights Reserved.
References (Click to open/close)
- Retroversion of uterus. (n.d.). MedGen. Retrieved from ncbi.nlm.nih.gov/medgen/452358
- Whelan, C. (2019, April 9). Retroverted Uterus: Causes, Fertility, Treatment, and More. Healthline. Retrieved from healthline.com/health/womens-health/tilted-uterus
- Retroversion of the uterus. (2020, March 31). U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/001506.htmRetroversion of the uterus. (2020, March 31). U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/001506.htm
- O’Grady, J. P. (2018, August 1). Malposition of the Uterus: Overview, Uterine Retroversion or Incarceration, Uterine Torsion. Medscape. Retrieved from emedicine.medscape.com/article/272497-overview
- Haylen, B. T. (2006). The retroverted uterus: Ignored to date but core to prolapse. International Urogynecology Journal, 17(6), 555-558. doi:10.1007/s00192-005-0051-0
- Tobah, Y. B. (2019, November 22). Tilted uterus: Can it lead to infertility? Mayo Clinic. Retrieved from mayoclinic.org/tilted-uterus/expert-answers/faq-20058485Tobah, Y. B. (2019, November 22). Tilted uterus: Can it lead to infertility? Mayo Clinic. Retrieved from mayoclinic.org/tilted-uterus/expert-answers/faq-20058485
- Joannides, P. (2012, May 22). A Tipped Uterus and Intercourse Positions. Psychology Today. Retrieved from psychologytoday.com/us/blog/you-it/201205/tipped-uterus-and-intercourse-positionsJoannides, P. (2012, May 22). A Tipped Uterus and Intercourse Positions. Psychology Today. Retrieved from psychologytoday.com/us/blog/you-it/201205/tipped-uterus-and-intercourse-positions
- Pelvic relaxation and retroverted uterus. (2018, August 8). UNC Department of Obstetrics & Gynecology. Retrieved from med.unc.edu/obgyn/patient_care/specialty-services/our-services/pelvic-relaxation/
- Cagnacci, A., Grandi, G., Cannoletta, M., Xholli, A., Piacenti, I., & Volpe, A. (2013). Intensity of menstrual pain and estimated angle of uterine flexion. Acta Obstetricia et Gynecologica Scandinavica, 93(1), 58-63. doi:10.1111/aogs.12266