The most frequent position of the uterus is forward or anteverted with its closed end higher than the cervix. If it tilts backward and down, this is known as retroversion.

Retroversion of the uterus occurs in about one in five women. Often there are no symptoms. But in some cases, a woman may experience backache, especially during menstruation. A retroverted uterus can also make intercourse painful.

"The most common symptom associated with a tilted uterus is backache. This is probably a result of blood trapped in the uterus, causing the uterus to become enlarged and tender. This uterine tenderness inflames the nerves of the back and results in severe backache," according to Dr. Niels Lauersen, a diplomate of the American Board of Obstetrics and Gynecology, and Steven Whitney in "It's Your Body: A Woman's Guide to Gynecology."

In the past, it was thought that retroverted uterus would make childbearing difficult if not impossible, and that surgery was needed to "correct" the condition. This wrong belief was reinforced by dishonest physi¬cians who made a killing with many needless surgical operations.

"The belief then was that a woman with a tilted uterus could not have a baby, so an operation was performed to rotate the uterus into the 'correct' - that is, forward - position. This was all nonsense. The position of the uterus is determined by genes. If your mother had a retroverted uterus, the chances are you will also have one. But your mother gave birth, and you can certainly have children, all other factors being equal. Unfortunately, the operation on the tilted uterus pro¬vided these doctors with a good source of income, and today, even though we know better, there are still many operations of this type performed. It cannot be over¬stated: The position of your uterus does not make any difference to your health or to your ability to have children," Lauersen and Whitney said.

The physician can easily tell if the uterus is retroverted or not during a pelvic examination. If it is, no treatment is necessary since retroversion is not a disease. Pregnancy can sometimes correct the condi¬tion but it does not cure retroversion. The condition may return after a woman has given birth.

If it doesn't bother you, stop worrying about it. In women who find intercourse painful, the doctor may recommend the use of a pessary, a rubber cap that puts the uterus in its correct position. If there is severe pain, surgery may be required to fasten the uterus perma¬nently.

"Treatment depends on the severity of the symp¬toms. When no symptoms are present, no treatment is necessary. If the symptoms are minor, some doctors simply prescribe an exercise regimen, stressing exer¬cises in the knee-chest position to allow the uterus to fall forward and empty any congested blood," Lauersen and Whitney explained.

"If your gynecologist suggests surgery, you should solicit a second opinion from another doctor. Surgery is sometimes required, but more often it is abused. The surgery is not dangerous: it is often merely unneces¬sary. The operation basically entails tightening the ligaments which pull the uterus forward," they con¬cluded.

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