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A retroflexed uterus is oriented in a backward-tilting position when compared to a normal uterus. Also called a tipped or retroverted uterus, in this condition the top of the uterus points towards the back of the pelvic region rather than tilting towards the bladder. Causes of a retroflexed uterus include pregnancy and complications from endometriosis or fibroids. In many women, a tipped uterus produces no symptoms, but others experience a range of difficulties especially when other problems are present. This condition is found in approximately 20 to 25 percent of women, and treatment options are available.
Some medical professionals view this condition as a normal variant of uterus positioning. In past centuries, it was considered an unhealthy uterus and attempts were made to reposition the retroverted uterus even when no symptoms were present. A history of endometriosis, fibroids or other disorders may cause or complicate a retroverted uterus. Pelvic adhesions resulting from endometriosis may immobilize a tipped uterus and require intervention.
Other causes of a retroflexed uterus include stretching of ligaments that hold the uterus in place during pregnancy. Once stretched, the connective tissue cannot hold the uterus in its normal, forward-facing position and the tip of the uterus, the fundus, may flop backward. Pelvic inflammatory disease can also cause a tipped uterus. It may also occur as a natural variation in the position of the uterus.
While some women with a retroflexed uterus experience no problems, others may have severe symptoms. Problems are generally more apparent when a retroverted uterus is accompanied by fibroids or endometriosis. Painful intercourse and menstruation are the most common symptoms. There may also be back pain during menstruation or intercourse. Urinary tract infections and minor incontinence might also be experienced.
It is believed this condition does not normally interfere with fertility. Once pregnant, by the 10th to 12th week the uterus changes size and orientation, and will usually be oriented normally. After childbirth, the uterus may return to its tilted position. In very rare cases, something called an incarcerated uterus might occur during pregnancy. This happens when the retroverted uterus does not reorient and becomes caught on pelvic bone, causing pain and difficulty urinating.
Treatment options include special exercises, surgery and a pessary. There is debate in the medical community about the effectiveness of exercise and the use of a pessary. This is a device that is positioned in the vagina to support the uterus but may cause infections and hamper intercourse. Surgery is used to suspend a retroflexed uterus, relieving some pain during sex or menstruation. It is generally used only when there are also other problems, such as endometriosis.
Tilted uterus symptoms include painful sex and the most pain when in the "on-top" sexual position, along with painful periods.