The uterus is a small fist-sized organ located above a woman’s vagina. Its primary role is to nourish a developing fetus during pregnancy.

In most women, the uterus is positioned forward, toward the belly. However, between 20% and 30% of women have a “tilted uterus” (also called a tipped uterus or retroverted/retroflexed uterus) which tips toward a woman’s spine and rectum.

Often, a tilted uterus is genetic. But it can also occur as a result of:

• Adhesions. When a woman has pelvic or abdominal surgery, scar tissue called adhesions may form and pull the uterus back, impacting its position.
• Endometriosis. This condition occurs when cells from the endometrium – the uterine lining – are located outside the uterus. These cells can make the uterus attach to other organs.
• Uterine fibroids. These benign tumors can cause the uterus to tilt.
• Pregnancy. When a woman is pregnant, the ligaments that hold the uterus steady can stretch to the point that it tips.
• Menopause. As a woman gets older, and her menstrual cycles stop, her estrogen hormone levels decline, which can impact the ligaments that hold the uterus in place.

A tilted uterus is usually not a problem. Some women aren’t even aware that they have a tilted uterus until a health care professional or gynecologist tells them so. Most of the time, a tilted uterus does not cause problems for conception or pregnancy.

However, in some women, a tilted uterus can sometimes make sexual penetration difficult. Some women find that rear-entry positions and deep thrusting may cause discomfort.

Couples in this specific situation are encouraged to experiment and try other positions that are more pleasurable. Intercourse may be more comfortable when the woman has more control over the depth of penetration.

Sometimes, a tilted uterus can be a symptom of another pelvic condition, such as endometriosis or pelvic inflammatory disease. Women may experience abdominal pain, pelvic pain, or irregular menstrual periods.

Women who have a tilted uterus – or think they might – should speak to their health care professional. Sometimes, prescribed pelvic exercises can temporarily move the uterus to a forward position. Other women benefit from a pessary – a plastic vaginal device that helps keep the uterus in place.

In more severe cases, a tilted uterus can be repositioned through surgery.