Typically, your uterus tips forward at the cervix (a cylinder-shaped neck of tissue that connects the vagina and uterus). A tilted or tipped uterus tips backward instead of forward. It’s considered a normal anatomical variation.
What Does It Mean?
The position of a uterus can vary from one woman to another. Most commonly, the uterus lies horizontally over the bladder, pointing toward your belly. A tilted uterus, however, angles back toward your rectum. About one-quarter of women have a tilted uterus.
While a tilted uterus usually isn't problematic, some women can experience the following symptoms:
Pain during sex. Due to the position of your tilted uterus, your partner can easily bump your uterus and even your ovaries during sex, causing discomfort. This can be especially painful in woman-on-top sex positions.
Tearing. During vigorous sex, it is possible to tear ligaments surrounding the uterus, which may require medical care.
Menstrual Pain. If you have a tilted uterus you might experience more menstrual pain than usual, especially if you have a related condition such as endometriosis.
Cause of a Tilted Uterus
Some of the causes of a tilted uterus include:
- Menopause. As you age, the ligaments holding your uterus can weaken, resulting in a backward tilt.
- Adhesions. Pelvic surgery can cause a band of scar tissue to form, which can pull the uterus into a tilted position.
- Endometriosis. Endometriosis is a medical condition where cells that usually grow inside the uterus are found growing outside the uterus. The cells can "glue" the uterus to other organs, causing it to tilt.
- Fibroids. Fibroids are noncancerous tumors that can cause your uterus to tilt backward.
- Genetics. Tilted uteruses might run in your family.
How to Tell if You Have a Tilted Uterus
Some common symptoms of a tilted uterus include:
- Pain during sex
- Pain during your monthly menstrual cycle
- Involuntary urine leakage
- Urinary tract infection
- Pain or discomfort while wearing tampons
Pregnancy and a Tilted Uterus
Some women worry that having a tilted uterus will hurt their chances of becoming pregnant. Luckily, the position of the uterus has nothing to do with your ability to carry a child. In fact, pregnancy might even cause your uterus to tilt backward.
Diagnosing a Tilted Uterus
To determine if you have a tilted uterus, your doctor will complete a pelvic exam. Your doctor will examine your reproductive organs during this exam, including your vulva, vagina, cervix, ovaries, uterus, rectum, and pelvis.
The doctor will insert two fingers into your vagina and push the cervix. With their other hand, they will press down on your abdomen to gently capture your uterus in both hands. This way they can check the size and position of your uterus and check for abnormal growths.
Your doctor may also complete a pap test (also known as a pap smear) to determine if another underlying condition, such as endometriosis or fibroids, is causing your uterus to tilt.
During a pap test, your doctor will place a tool called a spectrum inside your vagina to allow them to see your cervix. They use a soft brush to collect cells from your cervix and send those cell samples to a lab for evaluation.
Treatment Options for a Tilted Uterus
Each woman's body is unique. Your doctor can help you determine the best treatment option for you. Some of the most common options include:
Hormone therapy. Hormone therapy reduces the estrogen hormones in your body. Reducing estrogen hormones helps reduce pain and treat symptoms of underlying conditions (namely endometriosis). The most common form of hormone therapy is birth control in the form of patches, pills, or rings.
Exercises. In some cases, a doctor may be able to reposition the uterus during a pelvic exam manually, and practicing pelvic exercises might keep it in place. There are mixed reviews from medical professionals about the effectiveness of these exercises. In many cases, even after the uterus is repositioned, it eventually tips backward again.
Pessary. To help the uterus stay propped forward, your doctor may insert a plastic device. This could be done temporarily or permanently. The drawback of using a pessary is that there may be a risk of infection or inflammation. With a pessary you may still experience pain during sex, and the plastic device may cause your partner discomfort during sex as well.
Surgery. During surgery, the uterus can be repositioned to sit above the bladder. In some cases, your doctor may recommend complete removal of your uterus (known as a hysterectomy). Surgery is straightforward and usually very successful.