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By Beverly Whipple, PhD, RN, FAAN

Professor Emerita
Rutgers University of New Jersey
New Brunswick, NJ

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Q: It was discovered through an ultrasound that I have a retroverted uterus. My doctor told me that it may cause painful sex. Now I'm worried. I'm 19, a virgin and feeling depressed that sex may always be painful for me. I have always had very painful periods. What can I do to reduce the pain involved with sex?

First, relax. You don't know for sure that sex will be painful, but if you get it into your mind that it will, then it most assuredly will! Such is the power of the mind. You have what is also known as a retroflexed uterus, or a tipped uterus. About one in four women have this anatomical difference. It simply means that your uterus is tilted away from your abdomen instead of in a straight, up-and-down position or tilted slightly toward the abdomen. Most women are born with a retroflexed uterus, although it can occur as a result of pregnancy, aging or scar tissue from reproductive surgeries.

There is little evidence that a tipped uterus can cause painful intercourse. Only one study has ever been conducted to explore this issue, and it wasn't a very well-designed study. Nonetheless, while it found that 67 percent of women with a retroverted uterus had pain during intercourse, the pain was relatively low level and didn't interfere with the women's daily activities or their sexual activity.

The pain is thought to be caused when the tip of the penis hits the cervix of the uterus during intercourse. Another theory is that the ligaments holding the uterus actually move in a different direction than the uterus during intercourse, causing pain. Finally, a third theory suggests that having a tipped uterus leads to another condition called pelvic congestion, or venous congestion, which often results in pelvic pain.

If you find intercourse painful once you are in a sexual relationship, something as simple as changing the positions of vaginal intercourse may reduce the pain. If the pain continues and is affecting your relationship and/or quality of life, you may wish to talk to your health care professional about surgery, although this should only be considered as a last resort. You should probably also talk to your health care professional or a mental health professional about the depression you say you feel over this. Talking through your fears is often the best way to banish them.