Retroverted Uterus, Pregnancy and Childbirth: What You Need to Know

The uterus is the main organ of the female reproductive system. It is pear-shaped and located in the  pelvic cavity , between the bladder at the front and the rectum at the back. The absence of symptoms related to uterine retroversion is common. It is therefore often discovered incidentally by the practitioner during a gynecological check-up.

In most cases, the uterus is turned forward, that is, towards the belly, it is said to be anteverted. In this case, the vagina, which is oriented backwards near the rectum, forms an elbow with the uterus that goes forwards.

In some cases, the uterus is oriented backwards, that is, towards the spine, towards the rectum, forming a different angle with the vagina: this is the definition of a retroverted uterus. So, is it serious?

A retroverted uterus is not pathological at all, it is simply an anatomical variant or an anatomical peculiarity very common in women. It is a bit like having blue or brown eyes.

It also happens that the position of the uterus is intermediate, neither totally retroverted nor totally anteverted.

The diagnosis of a retroverted uterus is very easy to make during a clinical examination, when the obstetrician-gynecologist places the speculum: the axis of the cervix is ​​vertical and upwards. A pelvic ultrasound can also confirm uterine retroversion. But since it is a non-pathological anatomical peculiarity , the term diagnosis is even an abuse of language, and it would be more accurate to speak of identification.

Although there are few studies on the subject, it would seem that the position of the uterus is not a hereditary characteristic but only the result of chance. A woman whose uterus is retroverted is therefore no more likely than another to have a daughter with this same characteristic!

In the vast majority of cases, this positional abnormality does not cause symptoms outside of pregnancy.

However, some women report pelvic pain located in the lower abdomen or lumbar region during menstruation , called dysmenorrhea, or during sexual intercourse. The latter, called dyspareunia , could occur when the partner's penis comes up against the cervix, which is stuck to the vagina when the uterus is retroverted.

No specific treatment exists - outside of pregnancy - to restore the uterine position.

In case of severe pelvic pain during intercourse related to uterine retroversion, the couple can adapt by favoring certain positions over others. For example, they can be advised to avoid positions where penetration is the deepest - such as doggy style - in favor of others such as missionary or spooning .

"However, it is difficult to affirm that dyspareunia is caused by retroversion of the uterus, since many women are subject to it, even with an anteverted uterus," .

For women suffering from endometriosis , the disease sometimes causes adhesions that can tilt the uterus from front to back: this is called secondary or acquired retroversion, and no longer primary as when the retroversion is present since birth (congenital origin). The symptoms and pain felt by these women come from endometriosis and not from uterine retroversion.

To all women who are concerned about whether a retroverted uterus can limit their chances of getting pregnant: rest assured, a retroverted uterus does not cause infertility problems.

A retroverted uterus does not in any way reduce a woman's fertility. 

A retroverted uterus does not prevent sperm from reaching the egg and does not block the course of pregnancy. There are therefore as many pregnancies in women with a retroverted uterus as in those with an anteverted uterus, and fortunately so!

Uterine retroversion also does not interfere with various medically assisted procreation (MAP) techniques, whether in vitro fertilization (IVF), ovarian puncture or artificial insemination .

This anatomical variant therefore does not prevent conception in any way, and there is no need for any particular instructions to achieve this.

Although a retroverted uterus does not cause any particular symptoms outside of pregnancy, it can, however, cause some unpleasant sensations of heaviness, or even pain, during pregnancy . "Women can feel things more towards the back, like a weight," describes the specialist, "then, when the uterus begins to grow, towards the end of the first trimester, the particular angle of the cervix (when the uterus is very retroverted) can in some cases block urination  ," indicates the specialist. "They can in fact have difficulty urinating, called dysuria."

A vaginal maneuver is then proposed by the obstetrician-gynecologist. "This maneuver - performed under anesthesia because it is a little painful - is done by vaginal examination: we go to the very back of the vagina, in the cul-de-sac located between the rectum and the uterus, to push the bottom and tilt it forward and upward," describes Professor Deruelle. This maneuver presents no risk of complications for the mother or the baby, and always works very well.

Some doctors suggest that a retroverted uterus during pregnancy may increase the risk of organ prolapse - also called genital prolapse - after childbirth. It is very difficult to establish a cause-and-effect relationship between the two phenomena and therefore difficult to blame uterine retroversion in cases of organ prolapse in women.

It is sometimes said that a retroverted uterus could cause bleeding at the beginning or middle of pregnancy when the uterus is put back into place. "A priori, there is no reason for a retroverted uterus to cause bleeding during pregnancy  ," says the specialist. Bleeding should therefore not be attributed to this anatomical variant, at the risk of missing another diagnosis. Any loss of blood should prompt the pregnant woman to consult a doctor quickly.

As the pregnancy progresses and the uterus increases in volume and takes up more and more space, it spontaneously returns to an anteverted position. This phenomenon is generally observed from the fourth month of pregnancy .

The initial position of the uterus has no impact on childbirth since it will always have returned to an anteverted position at the end of pregnancy. The baby takes up more and more space in the pelvic cavity and returns forward, so that the notion of the position of the uterus disappears.

After childbirth , the uterus will return to its original position: a woman whose uterus was retroverted before her pregnancy will therefore have a retroverted uterus again after childbirth.