Recently, I came across the phrase “tilted uterus” in a story collection (this one — read it immediately). It reminded me I’d actually seen it before, mainly in literature, but there was never any elaboration about what it actually is or what it means. The term was usually mentioned in relation to infertility, but after an investigation, it turns out it’s much more complicated.
If your uterus is tilted, it means that it points backward, in the direction of your spine and rectum instead of forward, toward your stomach. A tilted uterus might be the reason for painful sex, especially when there’s penetration from behind.
“When I speak with my clients who are experiencing painful sex, asking if they have been diagnosed with a tilted uterus is one of my first questions,” said Sunny Rodgers, a clinical sexologist, certified sex coach and ACS-certified sex educator accredited by The American College of Sexologists — who also has a tilted uterus. “I will suggest certain sex play positions to lessen pain and discomfort if a client does have a tilted uterus.”
You might also have issues inserting tampons or menstrual cups, the perpetual existence of urinary tract infections, unpredictable periods and incontinence. (Keep in mind these are also symptoms of other conditions, so don’t diagnose yourself with a tilted uterus. Leave that to your OB-GYN to do during a pelvic exam.) And while you might experience these symptoms, you also might not.
It is rare to develop a tilted uterus (also known as a tipped uterus, retroflexed uterus, retroverted uterus, uterine retroversion or a backward uterus) due to a condition, though it can be caused by a handful of things, such as adhesions (scar tissue, such as that caused by a surgery), endometriosis, uterine fibroids, pregnancy and menopause. However, it's typically genetic according to the International Society for Sexual Medicine.
Angel was diagnosed with a tilted uterus when she was 22. “I was told I’d have difficulty getting pregnant because of the tilt and that it was the explanation for my brutal periods. This was an older male doctor (he’d delivered my younger brother in ’67.)” She later switched to a female doctor, who told her that her intense periods had nothing to do with the tilt — they would be relieved once she had children — but that it might mean she’d have fertility challenges. She didn’t. “I succeeded both times I tried. Periods became much more bearable after pregnancy. Normal and relatively simple births, both times. No mention of the ’tilt’ during either pregnancy or delivery.”
A tilted uterus probably won’t affect your ability to get pregnant, but some folks don’t know they have a tilted uterus until pregnancy. You might experience pressure on your bladder during your first trimester, and the tilt might also necessitate the use of a transvaginal ultrasound instead of a regular one. Pregnancy also causes your uterus to get bigger and straighten many times, so it won’t be tipped anymore, although sometimes this doesn’t happen, and that increases your odds of a miscarriage. Your doctor can diagnose this and fix it, but you should alert them to the occurrence of incontinence, abdominal pain and/or constipation.
While you likely won’t need any treatment for your tilted uterus, doctors might recommend exercises, such as Kegels, to strengthen the muscles that keep it upright. There are surgeries that can be done to reposition the uterus if your symptoms are particularly intense, and a pessary can be inserted into your vagina in order to prop up your uterus.
Just know that if you're one of the 20 to 30 percent of uterus owners whose womb is tilted, there are ways to treat it and yes, pregnancy is possible.
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