Can a retroverted uterus cause dyspareunia (pain during sex)?

Dyspareunia and Retroverted Uterus: Causes and Management

A retroverted uterus can cause dyspareunia (pain during sexual intercourse) when deep penetration causes pressure on the uterus, particularly when it is fixed in a posterior position. This occurs because the uterus is tilted backward toward the rectum rather than forward toward the bladder, which can result in pain during deep penetration.

Mechanism of Pain with Retroverted Uterus

• When the uterus is retroverted, deep penetration during intercourse can cause:
  • Direct pressure on the posterior uterus
  • Stretching of uterine ligaments
  • Compression of surrounding structures
  • Pain that is typically described as deep pelvic pain

Evidence for Dyspareunia with Retroverted Uterus

According to clinical guidelines, dyspareunia is a recognized symptom associated with a retroverted uterus. The British Journal of Dermatology guidelines note that dyspareunia can occur in various conditions affecting the genital area, including when there are anatomical variations that cause pain during intercourse 1.

Research evidence shows that women with retroverted uteri who undergo uterine suspension procedures experience significant improvement in dyspareunia symptoms:

• In a study of 75 women with chronic pelvic pain and dyspareunia associated with retroverted uterus, pain with intercourse decreased from 8.1 to 1.5 on a 10-point scale after uterine suspension procedures 2.
• Another study found that 88% of patients had improved sexual life after uterine suspension procedures for retroverted uterus 3.

Differential Diagnosis

It's important to note that dyspareunia has multiple potential causes, and a retroverted uterus is just one possibility. Other causes to consider include:

• Vaginal dryness
• Pelvic inflammatory disease
• Endometriosis
• Pelvic organ prolapse
• Lichen sclerosus (which can cause dyspareunia due to erosions, fissures, or introital narrowing) 1
• Postpartum sexual dysfunction (affects up to 35% of women) 1

Management Options

When dyspareunia is confirmed to be caused by a retroverted uterus, treatment options include:

Conservative Approaches:

• Position modifications during intercourse (avoiding deep penetration)
• Pelvic floor exercises to improve support
• Use of lubricants if concurrent vaginal dryness exists

Surgical Interventions:

• Laparoscopic uterine suspension is the definitive treatment when conservative measures fail 4. Effective techniques include:
  • UPLIFT procedure (Uterine Positioning by Ligament Investment, Fixation and Truncation)
  • Webster-Baldy method
  • Round ligament plication

The UPLIFT procedure has shown excellent results, with 84% of patients reporting essentially no pain after the procedure 2. Similarly, the Webster-Baldy method demonstrated that 80% of patients had complete relief from pelvic pain and dyspareunia after 6 months 3.

Important Considerations

• A retroverted uterus is a normal anatomical variant in approximately 20-30% of women and doesn't always cause symptoms
• Dyspareunia should only be attributed to a retroverted uterus after other causes have been ruled out
• Surgical intervention should be considered only when:
  1. The retroverted uterus is confirmed as the cause of dyspareunia
  2. Conservative measures have failed
  3. The pain significantly impacts quality of life

Follow-up After Treatment

Case studies have shown that women who undergo laparoscopic uterine suspension can subsequently have successful pregnancies and vaginal deliveries, with the uterus remaining in the corrected position postpartum 5.

Regular follow-up is recommended to assess symptom improvement and ensure the uterus maintains its new position.