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, AKA 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 it is tilted or retroverted, it points backwards and down towards the lower back, instead.((Retroversion of uterus. (n.d.). MedGen. Retrieved from ncbi.nlm.nih.gov/medgen/452358)) Additionally, from being in a retroverted position (pointing backwards), some uterus-havers can experience a retroflexed uterus when it is also bent backwards.

A tilted or retroverted uterus may not always cause symptoms. If symptoms do occur, they can often be managed with 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, lower back or pelvic pain during sexual intercourse,
  • Painful periods, a.k.a. dysmenorrhea,
  • Slight urinary incontinence, and 
  • Feeling of pressure on the bladder.((Whelan, C. (2019, April 9). Retroverted Uterus: Causes, Fertility, Treatment, and More. Healthline. Retrieved from healthline.com/health/womens-health/tilted-uterus))

If you notice any of these signs or symptoms, consult your doctor or OB-GYN. A retroverted uterus diagnosis is not a cause for concern. Your doctor will provide treatment options and recommendations to manage any discomfort. In extreme cases, medical professionals 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.

in the clear urinary tract health support

What are the causes of a retroverted uterus?

Some individuals are born with a tilted 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.((Retroversion of the uterus. (2020, March 31). U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/001506.htm)) 

Retroverted Uterus Pregnancy

Pregnancy can also cause uterine retroversion, with the position of the uterus changing intermittently during gestation. A tilted uterus occurs in 10-20% of pregnancies in the first trimester.((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))

A tilted uterus pregnancy is typically temporary and rarely causes problems. 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 and what tests are needed?

Routine pelvic exams are a great starting point to discard many issues your vagina might have. However, your doctor or OB-GYN will request a transvaginal ultrasound or MRI in order to diagnose a retroverted or tilted uterus.((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))

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 believed that a tilted uterus could cause fertility problems. However, research has shown that sperm can navigate various uterine shapes and sizes. Recent studies have shown that a tilted or retroverted uterus doesn’t have any impact on a woman’s fertility.((Tobah, Y. B. (2019, November 22). Tilted uterus: Can it lead to infertility? Mayo Clinic. Retrieved from mayoclinic.org/tilted-uterus/expert-answers/faq-20058485))

Rarely, scar tissue in the uterus can cause a tilt and make it harder for sperm to reach an egg. It can be caused by endometriosis, infections, or prior surgeries.((Tobah, Y. B. (2019, November 22). Tilted uterus: Can it lead to infertility? Mayo Clinic. Retrieved from mayoclinic.org/tilted-uterus/expert-answers/faq-20058485)) If you’re worried about conceiving, consult your OB-GYN or fertility specialist. 

In terms of your sex life, a tilted 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 intercourse while others don’t? It’s because every tilt is different.A tipped uterus can affect the angle at which the vagina meets the cervix and the orientation of the pelvic floor muscles.((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-positions))

For some, positions in which the pelvic muscles are getting a ton of repeated pressure don’t feel so great.  

Tip: People with a retroverted uterus often find face-to-face positions most comfortable for penetrative sex. Another option is a “cross-wise” position.1((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/)) 

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 tilted uterus.((Retroversion of the uterus. (2020, March 31). U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/ency/article/001506.htm)) 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.

A study found that increased period pain intensity was associated with more extreme angles of uterine flexion, regardless of its direction (forward or backward).((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))

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.

flex reusable menstrual disc

Can a retroverted uterus be corrected and how?

A retroverted uterus, where the uterus tilts backward instead of forward, can often correct itself naturally over time. However, if it causes discomfort, a doctor may recommend exercises to strengthen the pelvic muscles or surgical intervention to reposition the uterus.

Key Takeaways

One in five people have a tilted uterus: It’s totally common and isn’t considered a medical problem but a normal anatomical variation. 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 have a retroverted uterus, consult your doctor first for symptom management. There are online groups and forums dedicated to discussing tilted uteruses that may be helpful. 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. 

© 2023 The Flex Company. All Rights Reserved.

  1. 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-positions []