Retroverted uterus

A retroverted uterus (tilted uterus, tipped uterus) is a uterus that is tilted backwards instead of forwards. This is in contrast to the slightly "anteverted" uterus that most women have, which is tipped forward toward the bladder, with the anterior end slightly concave.

One in three to five women (depending on the source) has a retroverted uterus, which is tipped backwards towards the spine.

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Related terms

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:

Additional terms include:

• retrocessed uterus: both the superior and inferior ends of the uterus are pushed posteriorly
• severely anteflexed uterus: the uterus is in the same position as "normal" and bends in the same direction (concave is anterior) but the bend is much pronounced
• vertical uterus: the fundus (top of the uterus) is straight up.

Causes

In most cases, a retroverted uterus is congenital, but some cases are caused by pelvic surgery, pelvic adhesions, endometriosis, fibroids, pelvic inflammatory disease, or the labor of childbirth.

Diagnosis

A retroverted uterus is usually diagnosed during a routine pelvic examination.

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

Fertility & Pregnancy

Uterine position has no effect on fertility. A tipped uterus will usually right itself during the 10th to 12th week of pregnancy.

If a uterus does not right itself, it may be labeled persistent. "Persistent retroflexion of the pregnant uterus is incompatible with advanced pregnancy. If spontaneous or artificial reposistion does not occur, the patient either aborts or develops symptoms caused by incarceration of the uterus before the end of the fourth month. In exceptional instances, however, pregnancy may proceed, resulting in uterine sacculation. Spontaneous delivery is impossible, and rupture of the uterus may occur."^[1]

Treatment

Treatment options are rarely needed, and include exercises, a pessary, manual repostioning, and surgery.

References

1. ^ Gant NF. Cunningham FG. Basic Gynecology and Obstetrics, 1995, p 375 - chapter 48