There’s a lot more visibility these days for the various conditions that can cause pain during sex. Netflix’s Sex Education featured a character with vaginismus; more people are having conversations about vulvodynia. And we’re all stocking up on lube to combat dryness and friction.
One condition that gets less attention, however, is a tilted or “retroverted” uterus, despite the fact that it affects about 20% of people with uteruses – me included.
I spent my first few sexually-active years assuming pain was a normal part of penetrative sex, and it nearly put me off sex in general. I was finally diagnosed by my ob-gyn during an STI test, and I was relieved to have some explanation for the pain. Through slow, patient experimentation, I found ways to alleviate the discomfort and truly enjoy sex.
My hope is that others can get diagnosed earlier than I did. As with most painful sex conditions there’s no cure-all solution, but a titled or tipped uterus definitely doesn’t have to stand in the way of pleasure. Talk to your doctor, communicate with partners, and take time to figure out what works for you and your unique body.
What Is a Tilted Uterus?
A tilted uterus is angled backward toward the lower back and rectum, rather than forward toward the belly button. It can affect the position of the cervix in the vagina, causing a kind of deep pain or discomfort during sex or while using tampons, as well as complications during pregnancy. A tilted uterus is sometimes referred to as a tilted cervix or a retroflexed uterus; they’re all the same thing.
This condition often goes undiagnosed and is technically considered a “normal anatomical variance.” In other words: the medical world believes that having a tilted uterus is normal and common.
That said, painful sex isn’t something you should have to put up with, so always talk to a doctor (or another “women’s health professional”) if you experience pain during sexual intercourse or other types of penetration. Doctors can usually diagnose it during a pelvic exam by using their fingers and checking the position of the cervix, which will help you understand the location of the pain.
Vaginismus is a muscular condition in which the vaginal walls contract when something is inserted, causing pain. It’s often linked to anxiety or fear around sex. Retroversion of the uterus, on the other hand, is considered a “normal variation” of a vulva-haver’s anatomy.
What causes a retroverted uterus? In patients with endometriosis, abnormal cells may cement the uterus to other body organs and cause it to tilt. Adhesions or scar tissue from pelvic surgery, or from untreated pelvic inflammatory disease (PID), may attach to the organ and pull it; the uterus tips as a result. Fibroids (tumors that aren’t cancerous) can cause a tilted uterus. And during menopause, ligaments that hold the uterus can become weak, allowing it to tilt.
But in other cases, it’s simply a product of genetics. It’s how some people are built.
The position of the uterus can’t be permanently changed. A drastic treatment approach is a hysterectomy (which involves removal of the uterus, and sometimes the ovaries). But for many people, there are less-severe treatment options. Others can overcome the symptoms with proper management.
What Symptoms Should I Look Out For?
Some people with tilted uteruses experience pain when the cervix is “hit” during penetration of any kind. The level of pain varies from person to person and depends on the exact position, but can range from dull to sharp. The pain can sometimes linger after sex, creating a “bruised” feeling deep in the belly. A retroverted uterus may also cause symptoms like regular urinary tract infections and urinary incontinence.
A tilted uterus doesn’t cause infertility, but it can occasionally cause some minor issues during the first trimester of pregnancy – like back pain, problems in passing urine, and difficulty locating the fetus during an ultrasound.
The condition can also make the cervix hard to find during gynecological exams; period products like menstrual cups, or birth control devices (like diaphragms), may not fit correctly.
Treatment Options for a Tilted Uterus
As I’ve mentioned, the drastic approach is hysterectomy, which is usually considered only for patients already in menopause.
Medical professionals often suggest less-invasive options.
- Lowering the body’s estrogen levels with hormonal birth control pills, rings or patches may treat underlying conditions like endometriosis, while reducing pain.
- Some gynecology specialists recommend a plastic device called a pessary, which can be inserted to prop the uterus up and keep it from tilting; that approach may not relieve all the pain associated with a retroverted uterus, it may cause discomfort for sexual partners as well, and the pessary itself could cause inflammation or infection.
- There are healthcare professionals who try manually repositioning the uterus for some of their patients, and then prescribe exercises or physical therapy to keep it from re-tipping. If that works, it’s often just a temporary fix.
The majority of people with a tilted uterus are faced with a difficult truth: they need to figure out how to continue their sex lives with as little pain as possible.
How to Have Sex With a Tilted Uterus
It’s entirely possible, promise! As with any condition that causes pain during sex, the slower the better. Take time to play around with different methods to help ease the pain. Remember, what works for one person might not for another – get creative and be honest about how things feel.
It’s always, always worth engaging in foreplay before inserting a penis or dildo, regardless of your uterus’s angle. For those with tilted uteruses it’s especially helpful, because the vagina can elongate during arousal. That means the tilted cervix is further away when something is first inserted.
Fear of pain can get in the way of arousal, so take time to relax, and communicate the issue to your partner so they know to take it slow. Concentrate on external pleasure (e.g. oral) before moving onto penetration, or take penetration off the table completely – it’s not a requirement!
You can explore and locate the cervix with your fingers, to get an idea of where exactly it’s located (it feels like a round bump with a dip in the middle). You can then direct your partners to avoid it when using their own fingers, e.g. by angling upwards, sideways, or whatever feels best.
Different sex positions
The Kama Sutra is your friend here! Try new positions that allow you to control the rhythm and depth. Any position with you on top works great. Here are some other sex positions that allow for shallower penetration:
- Spooning: Lie on your sides to allow shallower penetration from behind.
- On your sides facing each other: Lift your leg over their hips, so either one of you can control the rhythm.
- L shape: Lie on your back, and ask your partner to lie sideways at a 90-degree angle and lift your legs over their hips.
- Soft doggy: Lie on your front, with your partner stretched out full-length behind you.
- Shifted missionary: Lie on your back, with one leg between your partner’s, and the other wrapped around the side. This way penetration is shifted to the side slightly and therefore shallower.
You can also use a specially-designed wearable like the Ohnut during sex, to “customize penetration depth.” It’s a series of soft donut-like rings that can be placed on a shaft to essentially make it shorter.
It may also be helpful to avoid dildos with tapered or pointed ends. Instead, go for rounded ends to avoid pressing directly on the cervix.
If you do experience pain during sex, you can soothe it like you would menstrual pain – use a hot water bottle or heated pads like Private Packs.
Living With a Tilted Uterus
While a tilted uterus won’t affect your fertility or worsen over time, it can be a difficult thing to live with and it can cause fear, anxiety or frustration around sex. The more we talk about painful sex conditions, though, the easier it will be to support those with negative experiences and find new ways to alleviate their discomfort. Everyone deserves a positive sex life, however that looks for them.