Overview of Uterine Retroversion
Uterine retroversion (aka "tipped uterus" or "tilted uterus") affects approximately 25% of women. This can result in pelvic pain and discomfort with intercourse (dyspareunia) (Fauconnier et al., 2006). This condition can also cause pain with menstruation (dysmenorrhea) (Ott et al., 2010).
One cause of uterine retroversion is laxity of the uterine ligaments that maintain normal uterine position, due to menopause or childbirth. Pelvic adhesions due to prior surgery, endometriosis, and salpingitis can also generate tension on the uterus and cause it to tilt in a retroverted position. Additionally, uterine retroversion can be secondary to mass effect from uterine fibroids or pelvic malignancy.
Surgical methods, such as laparoscopic ventrosuspension of the uterus with mesh and/or ligament pexy, have been described to correct this condition (Ott et al., 2010; Perry et al., 2004; Carter 1999; Halperin et al., 2003). Although surgical treatment of uterine retroversion is not necessary (especially for asymptomatic patients), it has been reported to provide symptom relief in some patients (Ott et al., 2010).
Pessaries have been described as a nonsurgical option to reposition a retroverted uterus into an anteverted position as early as the 19th century (Murray, 1868). However, to our knowledge, the use of rectal plugs to correct uterine retroversion has not been reported in the medical literature.
We present a case of a healthy 31-year-old female with known uterine retroversion. Given the sensitive nature of the research, the participant was chosen because she was well-known to the researchers (a medical doctor), and willingly volunteered for the case investigation. She did not have a history of uterine fibroids or other uterine or pelvic pathology.
The position of the retroverted uterus was assessed in real-time as the plug was inserted into the rectum.
The results of this study demonstrate that inserting a plug into the rectum can shift a retroverted uterus into midposition. Uterine retroversion is a cause of sexual dysfunction due to pain with intercourse. Clinicians can use these findings to counsel patients about using a rectal plug during intercourse as a nonsurgical method to reduce dyspareunia.