The retroverted uterus

Dear Readers,

A.D. from Kingston is a 37-year-old woman. She has a 14-year-old daughter who was born by breech delivery (born bottom first). A.D. recently visited her gynaecologist and after her routine examination she was told that her uterus is RETROVERTED. A.D. asks "Will I still be able to conceive, and can breach birth cause this problem?" She is worried.

The most normal position of the uterus is almost at right angles to the vagina with a slight forward curve. The womb, therefore, lies towards the (anterior) abdominal wall. The body of the uterus is forward placed in over 80 per cent of women. This position is also thought to offer the best access that sperm would have to the uterus when assessing fertility. In the remaining 20 per cent of women, RETROVERSION is noted. Less than five per cent of these women have any problems related to retroversion. When the uterus is retroverted it is directed backwards, towards the spine. Sometimes the uterus is also curved backwards, known as RETROFLEXION, resulting in an alternation from what is considered to be the more normal position of the uterus in the pelvis.

Retroversion can occur due to "other" disease processes occurring in the pelvis. An ovarian cyst or a uterine fibroid can displace the uterus backwards while inflammation and scarring associated with Endometriosis and Pelvic Inflammatory Disease can tether the uterus backwards. If the uterus is found to be retroverted and there are no other associated complaints then the woman should be reassured as to her good physical and reproductive health. "Lifeline" assures A.D. that her retroverted uterus will not, in the absence of pelvic disease, have any effect on her ability to conceive. Nor is it likely that her "breach birth" contributed to the retroversion. Almost all women, immediately after delivery of a child, experience uterine retroversion TEMPORARILY.

In the normal retroverted womb which is not associated with other pelvic illness, pregnancy occurs just as readily as in any other woman. However, when other disease processes cause retroversion there may well be other, associated signs. Significant displacement of the uterus is associated with pelvic pain, backache, menstrual problems and infertility. Very few of the complaints experienced by women with uterine retroversion are due to the retroversion itself. Occasionally, backache, painful periods and heavy bleeding during periods can be due to over-congestion of the uterus and ovaries, but it is the associated disease which causes the problems.

A womb held firmly in the retroverted position by "scar tissue" can be the source of very painful sexual intercourse. Painful sex, backache, painful periods and heavy periods are associated with both womb infection and endometriosis whether the womb is normal "anterior" placed or is retroverted.

When the cause is not easily determined other investigations should be requested.

Uterine retroversion can be treated either surgically or by the insertion of a ring pessary at the neck of the womb which helps keep the womb in a better position. Usually this pessary does not interfere with sex and is left in place for several weeks. A retroverted uterus very rarely requires any treatment at all.

By DR AJ MORGAN

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