Contents
- Retroverted or anteverted uterus: what does it mean?
- CURVATURE OF THE UTERUS
- HOW TO GET PREGNANT WITH A TILTED UTERUS?
- WHAT CAUSES UTERINE INVERSION?
- SYMPTOMS OF THE BEND OF THE UTERUS
- DIAGNOSTICS OF THE BEND OF THE UTERUS AND TREATMENT IN “ON CLINIC RYAZAN”
- How to get pregnant with a retroverted uterus?
- Retroverted uterus: which positions to favor during intercourse?
- Painful periods, endometriosis …: the questions we ask ourselves
- Contraception, fertility, cup… having a retroverted uterus, what does that change?
Retroverted or anteverted uterus: what does it mean?
In the majority of women, the uterus is anteverted, that is to say, turned forwards. If the vagina is rather located towards the back, in the direction of the rectum or spine, the uterus is usually inclined forward, towards the abdomen. So there is an “elbow” between the vagina rather backwards and the uterus rather forwards.
More in about 25% of women, the uterus is retroverted. It is also called uterine retroversion. This is only an anatomical peculiarity, and not an anomaly. The uterus goes backwards, towards the spine, so the angle between the vagina and the uterus is not the same as when the uterus is anteverted. According to current medical data, this peculiarity is not a hereditary characteristic.
CURVATURE OF THE UTERUS
The uterus is the most important part of the female reproductive system. It is in the uterus that the development of the fetus occurs from the moment of conception to childbirth. This pear-shaped muscular organ is located in the small pelvis of a woman; on one side of it is her bladder, and on the other, her rectum.
Depending on the fullness of the organs adjacent to the uterus, it can change its position. For example, a full bladder causes the uterus to tilt forward. In general, the position of the uterus is considered normal, in which the angle between it and its neck is at least 120 degrees.
When the body of the uterus deviates in any direction and the angle at which the cervical part is directed towards it decreases to 110-90 degrees, gynecologists talk about the bend of the uterus. Most often – in about 7 cases out of 10 – there is a bend directed back or forward.
HOW TO GET PREGNANT WITH A TILTED UTERUS?
When a gynecologist diagnoses a uterine bend in her patient at an appointment , in 99% of cases the first question she will ask the doctor will be: “Is pregnancy possible?” In most cases, it is difficult to give an unambiguous answer to such a question – this is due to the fact that the presence or absence of possible problems is determined primarily by the severity of the violation.
As practice shows, practically guaranteed to be a complicated conception when the uterus is bent back. In addition, this type of disorder also complicates the bearing of the fetus and can lead to the development of various complications during pregnancy. Moreover, the increased risk to the fetus in this case persists at the time of delivery.
WHAT CAUSES UTERINE INVERSION?
There are congenital and acquired course of this pathology. Moreover, congenital bending of the uterus can be triggered by both genetic and external factors that influenced the fetus during its intrauterine development. As for the acquired disorder, it often develops in women after childbirth.
The most common causes of this pathology in women include:
- weak pelvic floor muscles, as well as a violation of their integrity;
- stretching and rupture of ligaments;
- the patient has sluggish chronic diseases of the pelvic organs, accompanied by inflammation;
- adhesive processes;
- various benign and malignant neoplasms on the reproductive organs.
SYMPTOMS OF THE BEND OF THE UTERUS
In the vast majority of cases, the disease has an asymptomatic course and is diagnosed based on the results of the examination. However, the more pronounced the slope, the higher the likelihood that the patient will be disturbed during menstruation by the outflow of uterine contents. This can cause the development of inflammation, the symptoms of which – discharge, pain in the lower abdomen – are likely to cause the patient to see a doctor.
However, in some cases, women who are diagnosed with uterine bending complain of:
- discomfort and even pain during intercourse;
- frequent urge to urinate;
- pain in the uterus during bowel movements;
- severe pain in the first days of the menstrual cycle;
- lack of pregnancy with active sexual activity without protection for a year or more;
- miscarriages .
DIAGNOSTICS OF THE BEND OF THE UTERUS AND TREATMENT IN “ON CLINIC RYAZAN”
The bend of the uterus is most often detected during the ultrasound of the pelvic organs . Hysterosalpingography , which is also performed in our multidisciplinary medical center under ultrasound control, is another instrumental study that is usually done in connection with the suspicion that the patient has another gynecological disease, as well as as part of pregnancy planning.
As for therapy aimed at treating uterine bending, it should include the elimination of the factor that provoked its development. The gynecologist may prescribe the patient anti-inflammatory, diet, vitamin or physiotherapy, as well as exercise therapy. In the most advanced cases, the patient may undergo surgery, during which the uterus will be fixed in the correct position. Most often, this is a minimally invasive operation using modern endoscopic techniques.
Uterus positioned back: possible symptoms
This anatomical difference does not prevent pregnancy and does not harm fertility. However, having a retroverted uterus can lead to pelvic pain (in the jargon we speak of pelvic pain) mild to moderate, especially in certain positions during penetrative sex, or even during menstruation. As the uterus is positioned backwards, the uterine cramps during menstruation can be felt more in the lumbar region (lower back) than in the lower abdomen.
Uterine retroversion: often seen during an ultrasound
The diagnosis of uterine retroversion is often made during a Pelvic ultrasound, whether it is a routine gynecological check-up, early pregnancy or looking for a pathology (cyst, endometriosis, etc.). Unless it appeared secondarily (see box below), uterine retroversion will not require further clinical examinations, especially in the absence of bothersome symptoms or associated pathology.
Primary retroversion and secondary retroversion
Note: uterine retroversion can also be subsequent, that is to say, not be present from birth. A distinction is thus made between “primitive” retroversion and “secondary” uterine retroversion.. The uterus can thus be passed from an anteverted position to a retroverted position, due to a uterine fibroid, adhesions between organs or endometriosis. After childbirth, retroversion of the uterus can also be transient, due to the relaxation of the ligaments holding the uterus in place.
Retroverted uterus: is there a treatment?
No treatment is generally offered for a retroverted uterus, as this anatomical peculiarity is of no consequence. If it is clearly identified that uterine retroversion is the only cause of particularly annoying pain or discomfort, laparoscopic surgery may possibly be proposed, with the complications that this intervention involves.
During pregnancy, if the retroverted position does not correct itself by the start of the second trimester, a vaginal maneuver may be undertaken by an obstetrician-gynecologist, to reposition the uterus in anteversion.
How to get pregnant with a retroverted uterus?
In reality, the key question would rather be “can you get pregnant with a retroverted uterus?”. The two questions lead to the same answer: no worries ! Having a retroverted uterus does not prevent you from getting pregnant and having a successful pregnancy, and does not require special methods to achieve this.
During pregnancy, in most cases, the uterus will naturally grow and evolve, so that the notion of anteversion or retroversion will no longer really make sense. “Exceptionally, as the uterus is very far back, the cervix tends to move forward and can block urination a little bit, but this is very exceptional ”, explained to one of our readers Prof. Philippe Deruelle, obstetrician-gynecologist at Strasbourg University Hospital and former secretary general of the National College of Obstetrician Gynecologists of France (CNGOF). ” As the pregnancy progresses, the uterus will spontaneously antevert, he will not remain retroverted until the end. The baby will come forward and take up more space, so much so that the notion of the position of the uterus will disappear. The initial position of the uterus therefore has no effect on childbirth ”he added.
Note that the sensations of tightness and possible pelvic pain in the first trimester of pregnancy, due to the increase in size and the straightening of the uterus, may be a little stronger in the presence of a retroverted uterus.
Retroverted uterus: which positions to favor during intercourse?
In the presence of a retroverted uterus, certain positions during penetrative sex can cause discomfort or even pelvic pain, called dyspareunies. They are often deep, and occur when the partner’s penis comes in contact with the cervix, deep in the vagina. The positions where the penetration is deep (doggy style and similar positions in particular) are thus more conducive to causing pain.
If it bothers us, then we can favor positions where penetration is shallower, like the Small spoons, the Andromache where the woman manages the penetration and the comings and goings, or the Lotus. Do not hesitate to try several positions and sexual practices to find the ones that suit the best.
Be careful, however, severe pelvic pain during or after intercourse may be linked to other causes (scar adhesions, endometriosis and / or adenomyosis, ectopic pregnancy, ovarian cyst, gynecological malformation, polycystic ovary syndrome, urinary disorders, constipation. …).
Painful periods, endometriosis …: the questions we ask ourselves
Although no study has shown a clear link to this regardless of the age of patients, it is possible that the retroverted uterus causes more painful periods, due to poorer menstrual flow.
Namely: endometriosis, due to the adhesions it can cause, can tilt the uterus back, into the retroverted position.
However, there is no clearly established causal relationship: it is not because we have a retroverted uterus that we necessarily have endometriosis, and conversely it is not because we has endometriosis that our uterus is necessarily retroverted. There are cases of endometriosis with an anteverted uterus as with a retroverted uterus.
Some doctors evoke a greater risk of organ descent (prolapse) with a retroverted uterus, but this link is not sufficiently substantiated to be affirmed with certainty.
Contraception, fertility, cup… having a retroverted uterus, what does that change?
About thefertility, the presence of a retroverted uterus has a priori no impact, if this anatomical feature is not associated with a pathology which decreases fertility (fibroma, endometriosis, adhesions, etc.). It also does not prevent the use of various medically assisted procreation techniques (ART) such as artificial insemination, ovarian puncture or in vitro fertilization.
Regarding contraception, a retroverted uterus does not prevent the insertion of an IUD. The installation could simply be a little more delicate for the practitioner.
The same goes for using a menstrual cup or tampons. Having a retroverted uterus does not change anything a priori. The same precautions should be taken when applying and removing these devices.
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