Backward tilt of the uterus

The backward tilt or backward buckling (retroversion or retroflexion) of the uterus is a deviation from the normal female pelvic anatomy, in which the uterine body is tilted backwards instead of forwards; It can be slightly shifted to the right or left.


Anatomy of uterus and vagina

The vagina is not perpendicular in the pelvis, but is directed towards the lower dorsal region.

In most women, the uterus is tilted forward so that it lies above the bladder and points with the upper end of the uterus (fundus) to the abdominal wall. A position variant is the vertical position of the uterus, the uterine fundus lies in a straight line above the vagina.
In about a quarter of women, there is a retroversion of the uterus, which means that the uterus is directed backwards, the uterine fundus is turned to the rectum. A backward-tilted uterus in most cases does not cause problems, occasionally women complain of discomfort, especially pain during sexual intercourse.

Shape variants of the uterus

Uterus septus The uterine cavity is separated into two parts by a septum (fibrous
The septum can divide only part of the uterus (incomplete septum) or extend to the cervix (complete septum).

Uterus bicornis
The usually pear-shaped uterus in this case resembles a heart, in the upper part there is a deep depression.
Because of this form, one speaks of a two-horned uterus.

What alternative names are there for the backward tilt of the uterus?

The backward tilt of the uterus can be expressed with various synonyms.
The doctor may use the following terms for this change in position:
backward buckling of the uterus, backward tilted uterus, retroflexion of the uterus, backward tilt of the uterus,
retroversion of the uterus,

retroversioflexio uteri.

What causes a retroverse uterus?

There are several causes of a backward-tilted uterus, including:

Genetic; the woman has had the retroverse uterus since birth.

Reasons for a later retroversion of the uterus:

  • Eine Entbindung kann die Retroversion der Gebärmutter verursachen.
  • If the ligaments used to attach the uterus lose tension during pregnancy, the uterus may shift backwards; in most cases, it returns to its normal position after delivery, especially if it is a mild retroversion.

Scar adhesions are caused by endometriosis or fibromas and can also lead to a backward tilt of the uterus.
Sometimes adhesion prophylaxis is used, which forms a barrier between organs and the surgical section to prevent the development of adhesions after surgery.Pregnancy During pregnancy, the uterus enlarges and its retaining ligaments slacken. As a result, many women have a retroverse uterus after childbirth.

Health problems of the reproductive system
Some gynaecological diseases, such as inflammation in the small pelvis and endometriosis, can cause a backward tilt of the uterus, because they may lead to the formation of scar tissue in the abdomen, which brings the uterus out of its original position.

Signs and symptoms of uterine retroversion or flexion:

  • Menstrual pain and pain during sexual intercourse
  • Back pain before and during menstruation.
  • Weak bowel movements or constipation just before or during menstruation (the uterus can double its size immediately before and during menstruation, from 120 g to 300 g. This means increased pressure on the rectum.
  • Unpleasant odor of menstrual bleeding (the toxins from the rectum can penetrate into the uterus).
  • There is no evidence that a retroverse uterus leads to infertility, but it could be harder to get pregnant.
  • Ovarian cysts due to inability of the ovarian follicles to release the egg to be fertilized.
  • Painful ovaries during ovulation.

When a woman becomes pregnant with a retroverse uterus, she may suffer from back pain and constipation until the adhesions that keep the uterus in the back position eventually break under the increasing weight of the uterus.

This usually happens after the 5th month of pregnancy. The woman may suffer from back pain at this moment and feel the displacement of the uterus forward.
This event is felt differently by every woman and depends on how long the backward tendency has already existed and how far it was pronounced; with a mild retroversion, the symptoms are weaker.

It is quite natural for the uterus to shift slightly forward and backward, such as the bladder and rectum, but if it is blocked in one position, it affects the surrounding blood vessels and organs (bladder and rectum), as well as the health of the uterus and ovaries. Retroversion/flexion can hinder ovulation and lead to the formation of an ovarian cyst.

Retroversion of the uterus can also cause posterior blood flow to the abdominal cavity, which produces endometriosis. As for the pain of ovulation, the ovaries can double in size during ovulation and get considerably closer to the lumbar muscle.

This phenomenon occurs mainly when the uterus is tilted backwards and the lumbar muscle has already retracted; this can affect the genitofemoral nerve, possibly causing pain in the front thigh up to the knee.

What effects does a retroverse uterus have on sexuality and fertility?

The retroversion of the uterus is not a disease but the change in position of an organ and does not mean that the woman is infertile; however, there may be problems with natural or artificial insemination.

A uterus tilted backwards does not cause miscarriage.
If the woman experiences severe pain during sexual intercourse, natural conception can become problematic.
Artificial insemination (in vitro fertilization) can cause difficulties if the doctor inserts the embryos.

Some people believe that if the uterus tilts backwards, a cesarean section is necessary; this is not the case, a natural birth can take place.

Retroverse uterus and sexual intercourse

An inclined uterus can cause problems for a woman in everyday life.
It is important to discuss with the gynecologist what life with a retroverse uterus can look like and what physical and surgical options exist to alleviate the problem.

Most often, pain is complained of during sexual intercourse.
A silicone pessary can be inserted into the vagina to keep the uterus in the front position; however, it increases the risk of infection and inflammation, also the pain during sexual intercourse can increase.
Together with the gynecologist, the woman should consider the different treatment options for retroverse uterus.

How to recognize the retroversion of the uterus?

A gynaecological examination can reveal the position of the uterus, but a uterus tilted backwards can sometimes be mistaken for a mass in the pelvic area or an enlarged fibroma.
A rectal-vaginal examination is helpful to distinguish between a mass and a retroversion of the uterus.
If necessary, a transvaginal ultrasound may be performed to determine the exact location of the uterus.

Treatment of a retroverse uterus

If the backward tilt of the uterus causes discomfort, there are the following treatment options:

Root cause treatment The treatment
of the underlying disease, e.g. hormone therapy for endometriosis.

Pelvic floor exercises
If the movement of the uterus is not hindered by endometriosis or fibroids, and if the doctor can manually align the uterus during the gynecological examination, the exercises can be useful. But not all doctors believe in the usefulness of pelvic floor exercises as a long-term form of therapy. In many cases, the uterus may tilt backwards again.

Manual therapy and osteopathy
Since the retroverse uterus may be caused by adhesions on its back, manual intervention can help release some of these adhesions and push the uterus forward.
The treatment is done via the abdomen or the inside of the vagina, for this reason an osteopath may be preferable.

A plastic or silicone pessary can be inserted into the vagina for a short time or permanently to keep the uterus in a forward-tilted position. However, the pessary is associated with an increased risk of infection and inflammation. Another disadvantage is that the woman is in pain during sexual intercourse, and the pessary can also cause discomfort to the partner.

Surgical treatment of retroversion
With the help of minimally invasive techniques of laparoscopic surgery, a position correction of the uterus can be made and positioned above the bladder. This procedure is relatively simple and usually works well.

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