What causes a tilted uterus?

What causes a tilted uterus?

In some women, the womb or uterus is tipped backward, pointing toward the lower back. This is known as a retroverted, tilted, or tipped uterus.

Usually, the uterus sits upright, in a vertical or up-and-down position. A tilted uterus is quite common, with 20 women out of every 100 having the condition.

Fast facts on tilted uterus:

  • Most of the time, having a tilted uterus will not cause difficulty becoming or staying pregnant.
  • Some women have no symptoms or idea that they have a tilted uterus.
  • Usually, no treatment is required for a woman with a tipped uterus.

What are the causes of a tilted uterus?

The uterus is a hollow, pear-shaped organ that sits in the lower part of a woman's pelvis. It is where a fetus grows during pregnancy.

A woman can have a tilted uterus for several different reasons:

  • Weakening of the pelvic muscles: After menopause or childbirth, the ligaments supporting the uterus can become lax or weakened. As a result, the uterus falls in a backward, or tipped position.
  • Enlarged uterus: An enlarged uterus due to pregnancy, fibroids, or a tumor can also cause the uterus to become tilted.
  • Scarring or adhesions in the pelvis: The uterus or pelvis can be scarred by conditions, including endometriosis, infection, or previous surgery. This scar tissue can pull the uterus backward and cause it to be tipped.
  • Genetics: Some women are born with a uterus in a tilted or tipped position.

Impact on fertility and pregnancy

Many women are concerned that having a tipped uterus will impact on their ability to get pregnant. The position of the uterus does not usually affect fertility, however. Doctors may consider it if a woman is having difficulties becoming pregnant, but only after other causes of infertility are ruled out.

Having a tilted uterus should not affect a woman's ability to have a healthy pregnancy. In fact, being pregnant may cause the growing uterus to tip backward. In most cases, there is no impact on labor or delivery.

Impact on sex

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A tilted uterus may cause penetrative sex to be uncomfortable or painful.
 Painful sex can be a problem for a woman. Doctors are unsure what causes this discomfort, though there are several theories:
  • A tilted uterus can cause the cervix to sit differently in the vagina. The pain may be caused by the way the penis bumps against the cervix during intercourse.
  • The ligaments supporting the uterus may be stretched and moved in a different direction than the uterus. This can cause pain or discomfort during sex.
  • Another theory is that a tilted uterus causes venous congestion in the pelvis, meaning the veins in the reproductive organs dilate and fill with blood.

Sometimes, simply changing positions can make painful sex less troublesome. Many women with a tipped uterus usually prefer positions where they can be face-to-face with their partner. It is important for women to communicate to their partner what is comfortable and what is not.

Symptoms

Some signs are typical in women with a tilted uterus, including:

How is it diagnosed?

A tipped uterus can be easily detected during a routine pelvic exam. A doctor will insert two fingers into the vagina to feel and push against the cervix slightly.

Next, the other hand is placed on top of the abdomen and pushes it in gently to capture the uterus between the two hands. This allows the doctor to feel the uterus to determine its shape, size, and position, and to feel for abnormal growths.

Women who are having pain during sex or other symptoms of a tipped uterus should consult with their doctor. These symptoms can be a sign of other, more serious conditions and the doctor can do diagnostic tests to distinguish this condition from something more serious.

Treatment

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A temporary treatment involves hugging the knees to the chest while lying down.
There are a few treatment options that can help to correct the position of the uterus.

These may be used if a woman has severe symptoms that interfere with her life or ability to get pregnant.

  • Pessary: A pessary is a device that is placed in the vagina. It helps to support the vaginal walls, uterus, and other pelvic structures and can help to reposition the uterus. A pessary is a temporary fix, as the uterus will revert to its original position once it is removed.
  • Surgery: For some women, surgery can reposition the uterus. Uterine suspension surgery is an outpatient procedure and can be done with or without the use of a mesh or sling. Lasting results and improvement of pain during sex are usually achieved from surgery.
  • "Knee-chest" position: Though not a permanent solution, bringing the knees to the chest, while lying down, can help to move the uterus temporarily into a more comfortable position.

Outlook

The outlook for someone with a tilted or tipped uterus is good. Though some women experience discomfort related to the position of the uterus, serious health problems are not usual.

It is always important for women to talk to a doctor about pain during sex or other symptoms, even if they suspect that a tilted uterus is causing the discomfort.