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How to Get Pregnant With a Retroverted Uterus

How to Get Pregnant With a Retroverted Uterus

Nicole Knight, AHCJ | September 11, 2020 | Getting Pregnant

Myths abound when it comes to sexual positions that supposedly help you get pregnant faster. Still, the notion that one position is more effective than another is scientifically baseless for most couples trying to conceive. 

However, sexual positions MIGHT matter when you’re trying to get pregnant if your uterus is tilted backward — what’s known as retroverted uterus. A retroverted uterus may make sex painful and could make it more difficult for sperm to reach the egg in certain sexual positions (1, 2, 3). 

Here we’ll outline a few reproductive health issues linked to a retroverted uterus and suggest sexual positions that may be more comfortable and effective when you’re trying to conceive with a backward-tilted uterus. We’ll also sort through the evidence on whether a retroverted uterus affects fertility or not, and if it does, precisely how that could happen.

What is a retroverted uterus?

Your uterus is a pear-shaped organ that sits on top of your cervix. Most women have a uterus that’s tipped slightly forward toward the belly button. But in around 1 in 4 women, the uterus and cervix tilt backward. This is called retroverted, and it’s the most common “malposition” of the uterus. You may have heard a retroverted uterus called by different names, such as tilted uterus, tipped uterus, backward uterus, or retroflexed uterus (1, 2, 3). 

Genes seem to play a role in whether your uterus is retroverted or not, as do conditions like fibroids, tumors, or weakening of the ligaments that support the uterus. The tilted position also may be caused by scar tissue from endometriosis, infection, or surgery (1, 3). 

Your healthcare provider can determine the position of your uterus in a pelvic exam or an ultrasound exam. If you’ve ever had an IUD, your gynecologist may have mentioned whether your uterus is retroverted or not at your insertion appointment (4).

A retroverted uterus doesn’t make you infertile (it’s complicated — more on this in a bit), but it may make sex painful for some women due to anatomical differences (3, 5, 6).

A retroverted uterus and pain during sex

Although there’s scant research on pain during sex and uterine position, one French research team did ask women during routine check-ups to complete a questionnaire about pain during sex. Gynecologists then recorded the women’s uterine position via a vaginal exam. Just over 66% of women with retroverted uteruses reported having painful sex, compared to 42.1% of women who didn’t have a tilted uterus. Perhaps unsurprisingly, 48% of the women with a retroverted uterus said pain limited their sexual activity (2).

These numbers are alarmingly high, though the authors did not perform ultrasounds or tests to rule out other causes of pain. Given this, it’s impossible to conclude a retroverted uterus was the root cause of painful sex for these women (2). 

Even so, the medical world has a few theories to explain why a retroverted uterus may cause dyspareunia, the medical term for pain during sex (2). 

Why a retroverted uterus may cause painful sex

Three ligaments anchor the uterus in place. Researchers theorize that the backward-tilted position of the uterus may cause undue stress on these ligaments during sex, thereby making sex painful (2).

Gynecologists writing in the European Journal of Obstetrics & Gynecology and Reproductive Biology further suggest that a “mobile” retroverted uterus (where stretched ligaments allow the uterus to move around quite a bit) might cause “collision dyspareunia.” This painful condition results when the thrust of the penis pushes against the vaginal wall and bangs against the uterus during sex (2). 

Forceful thrusting might also cause uterine ligaments to tear. As noted in Contemporary OB/GYN, “vigorous forceful intercourse,” particularly when the woman is on top during sex, may cause torn ligaments that make sex with your partner quite painful (6). 

What sexual positions are best with a retroverted uterus?

Although there’s no broad consensus on the best sexual position with a retroverted uterus, medical and fertility experts offer a few suggestions. 

A doctor’s manual, in an entry on the topic of dyspareunia, recommends sexual positions where the woman has more control over penetration and the depth of thrusts. These positions may not only feel more comfortable, but also might lessen the risk of developing stretched or torn ligaments (5).

To have the best chance at conception with a retroverted uterus, fertility doctor Dr. Marc Sklar, of the Fertility TV YouTube channel, suggests having sex from behind, or doggy style (which is pretty surprising given the depth of penetration possible in this position) (4). 

But, as Dr. Sklar explains, with a retroverted uterus, “the cervix and the uterus are tilted backwards and it’s not a direct shot when your partner penetrates through the vaginal canal.” He says the angle of doggy style corrects the misalignment, helping the penis to more closely line up with the cervix (4).

When trying this position — or any others, frankly — be sure to keep the lines of communication open throughout sex with your partner. It may help for the couple to communicate and discuss what level of penetration is comfortable and enjoyable. 

Does a retroverted uterus affect fertility?

There’s a lingering debate over whether a retroverted uterus can make it more challenging to conceive. According to the Mayo Clinic, fertility experts once believed a retroverted uterus affected fertility, but no longer think that’s the case. But again, as Dr. Sklar noted, a retroverted position might cause misalignment between the cervix and penis during sex (3, 4).

Relatedly, one 2012 study published in the International Journal of Fertility & Sterility sheds light on this issue. It reported lower pregnancy rates among infertile women with a retroverted uterus who were undergoing intracervical insemination (ICI). ICI is a form of insemination where sperm is injected near the cervix. Pregnancy rates were 16.7% among women with a retroverted uterus, compared to 25.3% in the group with a forward-tilted uterus (7). 

Explaining the results, the authors pointed out that “the cervix is always positioned downwards with an anteverted uterus (tipped forward uterus), ensuring that the semen and cervical mucus are in close contact during ICI treatment. Based on the results of this study, we propose that intrauterine insemination (IUI) would be a more suitable method of insemination in women with a retroverted uterus position (7).” 

If sex is painful for you, or you know you have a retroverted uterus, it’s definitely worth discussing with your doctor and exploring different sexual positions to see what’s best for your body and sexual pleasure and speaking with your doctor for further input. Plus, it might add some spice in the bedroom for you and your partner on your journey to pregnancy and parenthood.