I went in for my first pap smear a few months ago. My gynecologist is the dream gyno: young, hip, and very sex-positive. I expected to be in and out with no problems. It started off with the usual for any pelvic exam: get undressed, put on a gown, get up in the chair, and put your feet in the stirrups.
I waited patiently with my legs spread while my doctor, realizing the lamp she needed for seeing where she was inserting things (it’s dark up there) was out, called a nurse to grab another light. Instead, the nurse came in bearing a very hefty flashlight, explaining there were no other lights available. So now this was a tag team effort: my doctor reaching to find my cervix while the nurse held the flashlight at my feet. She was really digging in there, as she apologetically told me that it doesn’t usually take this long and that she was having trouble finding my cervix. I assured her I was fine when she added, “It looks like your uterus is flipped.”
Now, I’m not sure about others who’ve had pap smears… but the last thing I’m ready to hear while sitting in that vulnerable position is my doctor nonchalantly telling me my uterus is “flipped.” What does that even mean?
The technical term is retroverted uterus. As scary as that sounds, turns out it’s actually pretty common, affecting about 20% of people with vaginas. Normally, the position of the uterus is tilted backward, so that the bottom part — the cervix — is frontwards towards the stomach, and the top of the uterus is tilted towards the back. A retroverted uterus is tilted the opposite way, therefore the cervix is pointed more towards the back and the top of the uterus is towards the stomach. Essentially, this means a retroverted uterus extends more directly up and back toward the rectum, instead of folding over and hugging the bladder (if this is confusing, there are a lot of good google images out there). Usually, a tilted uterus is inherited genetically, although there are some conditions that can cause a uterus to become retroverted such as endometriosis, fibroids, or pelvic inflammatory disease.
So do people with tipped uteruses have to worry about anything different than people with normally oriented ones?
My biggest, most fearful questions centered around pregnancy and childbirth. After talking to my gynecologist and doing some of my own research, I found that a tilted uterus itself does not affect getting pregnant. In some cases, conditions that can cause tipped uteruses (mentioned above) may affect getting pregnant, but the orientation of the uterus itself should not. However, in most cases, a tipped uterus does not affect childbirth. Once the beginning stages of pregnancy have passed, the uterus usually pushes itself up and re-orients into the correct position. In rare cases, the uterus is not able to push up and gets caught in a retroverted position. This condition is called uterine incarceration and can lead to pregnancy complications, although it is extremely rare — occurring in less than 1% of births from people with a retroverted uterus. Still, if you’re pregnant, it’s always a good idea to mention to your doctor that you have a tipped uterus.
The most surprising and seemingly most important thing to know about having a tipped uterus is that it can affect the pleasure of sex. It’s common that a tipped uterus causes painful penetrative sex in some positions. This is mostly because, during penetrative sex, the penis/toy will more easily hit the walls of the vagina or bump against the cervix which can be painful. This is usually specific to the position. Positions in which thrusting is deeper can be painful, so avoiding these positions can be helpful. Sticking to positions where you can be in charge of the depth of penetration is ideal. Usually, people with flipped uteruses find doggy style and other back-entering positions to be more painful while finding that positions, where partners are facing each other, tend to work better.
Having a retroverted uterus is usually not a game changer, but at the very least, a good thing to be informed about. The only way to tell the orientation of your uterus is through a pelvic exam by a physician. It’s important that if you think you might have this condition, for reasons such as painful sex, that you talk to your doctor. There are other, more serious conditions that can present similar symptoms.