What are the treatment options for dyspareunia (painful sex) caused by a retroverted uterus?

Treatment Options for Dyspareunia Caused by a Retroverted Uterus

Laparoscopic uterine suspension is the most effective treatment for dyspareunia caused by a retroverted uterus, with success rates of 80-90% in relieving pain during intercourse. 1, 2, 3

Diagnostic Considerations

Before pursuing treatment, it's important to confirm that the retroverted uterus is actually causing the dyspareunia:

• Pain should be reproducible by palpation of the retroverted uterus during examination
• Rule out other causes of dyspareunia through:
  • Ultrasound to exclude uterine or ovarian abnormalities
  • Evaluation for endometriosis, which can coexist with uterine retroversion
  • Assessment for pelvic inflammatory disease (PID), which can present with dyspareunia 4

Treatment Algorithm

First-Line Options:

1. Conservative measures:

   • Position modifications during intercourse (positions that minimize deep penetration)
   • Lubricants during sexual activity to reduce friction and discomfort 5
   • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen before intercourse to reduce pain 6

2. If conservative measures fail, consider:

   • Pelvic floor physical therapy to improve muscle tone and reduce pain
   • Vaginal moisturizers for those with concurrent vaginal dryness 5

Definitive Treatment:

Laparoscopic uterine suspension is the definitive treatment when conservative measures fail, with several effective techniques:

1. UPLIFT procedure (Uterine Positioning by Ligament Investment, Fixation and Truncation):

   • Creates shortened, thickened, and strengthened round ligaments
   • Suspends the uterine fundus in a mildly anteverted position
   • 84-90% of patients report complete pain relief 1, 3
   • Average procedure time: 12-14 minutes
   • Outpatient procedure with same-day discharge

2. Webster-Baldy method:

   • 80% of patients experience complete relief from dyspareunia after 6 months 2
   • Maintains relief in long-term follow-up (6 months to 2 years)

3. Round ligament plication:

   • Mean pain scores decreased from 4.5 to 1.6 after surgery 7
   • 19 of 30 women remained completely free of dyspareunia after 2 years

Effectiveness and Outcomes

• Pain with intercourse typically decreases from severe (8.1/10) to minimal (1.5/10) following laparoscopic suspension 3
• Pregnancy is possible after these procedures, with reports of successful vaginal delivery 1
• Post-partum examination shows the uterus remains well-suspended in an anteverted position

Potential Complications and Considerations

• Delayed postoperative pain at suspension sites occurs in approximately 7% of patients 3
• Pain typically resolves within one week, rarely persisting for a month
• No significant intraoperative complications reported in studies
• Some patients (5-10%) may continue to experience dyspareunia despite anatomical correction, suggesting other contributing factors 3

Special Considerations

• If endometriosis is found during laparoscopy, concurrent treatment with CO2 laser excision/vaporization can improve outcomes 8
• For patients with vaginal dryness contributing to dyspareunia, vaginal moisturizers applied 2-3 times weekly can provide additional relief 5
• Patients with a history of sexual trauma may require additional psychological support alongside physical treatments 4

Laparoscopic uterine suspension represents the most effective long-term solution for dyspareunia caused by a retroverted uterus when conservative measures fail, with high success rates and minimal complications.