“You know you have a retroverted uterus, right?” the nurse casually said as she examined the grainy black-and-white image of my transvaginal ultrasound. A generously lubricated wand had been inside me for what felt like the length of a feature film as the nurse searched around my reproductive organs for signs of PMOS.
A retro-? I’d spent five years in a dozen different doctors’ offices trying to figure out why, at age 21, I’d started having painful sex (not to mention the years of previously routine gynae exams). But I’d never heard of a retroverted uterus, much less known I had one.
Turns out, I’m in good – if not particularly well-informed – company. Roughly 20 percent of women have a retroverted uterus, says Elizabeth Nakamura. While most uteruses are “anteverted,” meaning they lean forward toward the belly button, the top of my uterus leans backward toward the spine.
Most people with tilted uteruses are born with the condition, due to genetics, but you might find yourself with a tilted uterus after pregnancy or childbirth, which can shift the position of the uterus. Certain pelvic conditions, like endometriosis, pelvic inflammatory disease, very restricted pelvic floor muscles, or scar tissue from surgery, can also pull the uterus backward, says Nakamura.
And even if you’ve lived your life with an upright uterus, there’s no guarantee it will remain that way. Menopause’s swirl of changing hormones, including lower estrogen levels, can weaken your pelvic muscles and ligaments, Nakamura says, so they’re less able to support the original position of your uterus.
How A Tilted Uterus Can Impact Your Sex Life
“Although a tilted uterus is common and usually harmless, many people don’t learn they have one until a pelvic exam, pregnancy, or they experience discomfort during sex,” says Amy Stein “Conversations about sexual comfort often focus on libido or relationships rather than anatomy, so practical information about pelvic anatomy, pain during intercourse and adaptations isn’t always part of routine education.” Plus, even if a patient does ask a doctor, most aren’t taught how to respond to those questions or have resources at the ready, she says.
That said, many women have perfectly healthy and satisfying sex lives with retroverted uteruses. However, if you are feeling some discomfort, pressure, or a dull ache during sex, a tilted uterus might be why. “Because the top of your uterus is tipped backwards, the passage at the bottom of your uterus – the cervix – protrudes forward,” says Nakamura. “If the cervix is constricted or tender, deep penetration may be painful.”
This pain may be particularly difficult during menstruation, when the uterus and cervix descend slightly into the vaginal canal, Nakamura adds. Of course, this is dependent on a few things, such as the length of your vaginal canal and the size of the toy/penis.
READ MORE: The A to Z Of Sexual Wellness – Literally Everything You Need To Know
How To Make Sex With A Tilted Uterus More Enjoyable
The first defense for people with a tilted uterus – or anyone who experiences discomfort with deep penetration – is pelvic floor physical therapy, says Stein. This type of PT can help with pelvic floor muscle, visceral and scar tissue restrictions and tightness, as well as any nerve irritation surrounding the uterus.
A typical pelvic floor physical therapy appointment may look like strengthening and relaxing the pelvic floor through manual release (a.k.a. pelvic massage therapy), using internal tools like a pelvic wand, targeted muscle exercises and breathwork. Worth noting: While these interventions can create meaningful changes in pelvic floor function, specialised pelvic floor therapy may not be accessible for everyone.
For a DIY option, try these four techniques to ease pain and enhance pleasure from Stein:
1. Experiment with positions
For some people with tilted uteruses, certain sex positions, like doggy style, can create deep pressure and discomfort. That’s why Stein recommends positions where the receiving partner controls depth and angle, such as cowgirl or side-lying (“spooning”), for more comfortable penetration. Small adjustments can also make a big difference in reducing pain. For instance, the missionary position with a pillow underneath the hips can assist gravity in elevating the hips, and therefore the low-riding or protruding cervix will tilt backwards so there’s less chance it will be hit during penetration.
Best Sex Positions for Tilted Uteruses
Cowgirl
How to: The receiver straddles the giver’s pelvis, lowering themselves down onto their penis or strap-on. From here, the receiver “rides” the giver, bouncing up and down, grinding backwards and forwards, or sliding from side to side – whatever feels best.
Spooning
How to: Both partners lie on their sides, facing the same direction. The receiving partner bends their knees slightly, while the giving partner aligns their pelvis behind them and enters from the rear, adjusting rhythm through gentle thrusting or rocking.
Lifted Missionary
How to: The receiving partner lies on their back with a regular pillow or wedge-shaped sex pillow under their hips to elevate the pelvis. Then, the giving partner enters as they would in missionary, using the lifted angle to adjust depth and rhythm.
2. Use a depth-limiting device like the OhNut
Both experts recommend the OhNut, a set of soft, stackable rings worn at the base of a penis or toy, to reduce penetration depth while maintaining intimacy. Many couples find it helpful if deep penetration causes pain.
3. Prioritise arousal and lubrication
Increased arousal naturally lengthens and expands the vagina (a process called “vaginal tenting”) and lubricant can reduce friction and improve comfort, says Stein.
READ MORE: 3 Girl-On-Top Sex Positions That Will Let You Control All The Action
4. Use pillows for positioning
Placing a wedge-shaped sex pillow under the hips or otherwise using one to change the angle of penetration can help prevent painful contact against the cervix or vaginal walls, the experts agree.
Ultimately, if you experience pain with penetration due to a tilted uterus, consider it an opportunity to learn more about your body, comfort and pleasure. This does not have to be a barrier to a satisfying sex life, but an invitation to discover what feels best for your body.
Meet the Experts: Elizabeth Nakamura, PT, DPT, OCS, is a physical therapist and the owner of Tidal Physical Therapy. Amy Stein, DPT, BCB-PMD, is a pelvic floor physical therapist and author of Heal Pelvic Pain
Source: https://www.womenshealthsa.co.za/health/feed
