There’s a lot more visibility these days for the various conditions that can cause pain during sex. Netflix’s Sex Education featured a character with vaginismus, more people are having conversations about vulvodynia, and we’re all stocking up on lube to combat dryness and friction. One condition that gets less attention, however, is tilted or “retroverted” uteruses, despite the fact that it affects about 20% of people with uteruses—me included.
I spent my first few sexually active years assuming pain was a normal part of penetrative sex, and it nearly put me off sex in general. I was finally diagnosed during an STI test and was relieved to have some explanation for the pain. Through slow, patient experimentation, I found ways to alleviate the discomfort and truly enjoy sex.
My hope is that others can get diagnosed earlier than I did. As with other painful sex conditions, there’s no cure-all solution, but a titled uterus definitely doesn’t have to stand in the way of pleasure. Talk to your doctor, communicate with partners, and take time to figure out what works for you and your unique body.
What Is a Tilted Uterus?
A tilted (or “retroverted”) uterus is angled back towards the bowels, rather than forwards towards the belly button. It can affect the position of the cervix in the vagina, causing a kind of deep pain or discomfort during sex or while using tampons, as well as complications during pregnancy. It often goes undiagnosed and is technically considered a “normal anatomical variance.” In other words: Having a tilted uterus is normal and common. That said, painful sex isn’t something you should have to put up with, so always talk to a doctor if you experience pain during sex or other types of penetration. Doctors can usually diagnose it using their fingers and checking the position of the cervix, which will help you understand the location of the pain.
Vaginismus is a muscular condition where the vaginal walls contract when something is inserted, causing pain. It’s often linked to anxiety or fear around sex. A tilted uterus, on the other hand, is an anatomical condition – it’s just how someone is built, with no clear cause. There is no cure, but the symptoms can be managed.
What Symptoms Should I Look Out For?
Some people with tilted uteruses experience pain when the cervix is “hit” during penetration of any kind. The level of pain varies from person to person and depends on the exact position, but can range from dull to sharp, and can sometimes linger after sex, creating a “bruised” feeling deep in the belly.
A tilted uterus doesn’t affect fertility but can occasionally cause some minor problems during the first trimester of pregnancy—like back pain, difficulty passing urine, and difficulty locating the fetus during an ultrasound.
The cervix can also sometimes be hard to find during gynecological exams, and cup-based period products or contraceptive devices (like diaphragms) may not fit correctly.
How to Have Sex With a Tilted Uterus
It’s entirely possible, promise! Like with any condition that causes pain during sex, the slower the better. Take time to play around with different methods to help ease the pain. Remember, what works for one person might not for another – get creative and be honest about how things feel.
It’s always, always worth engaging in foreplay before inserting a penis or dildo, regardless of your uterus’s angle. For those with tilted uteruses it’s especially helpful, as the vagina can elongate during arousal, meaning the tilted cervix is further away when something is first inserted. Fear of the pain can get in the way of arousal, so take time to relax, and communicate the issue to your partner so they know to take it slow. Concentrate on external pleasure (e.g. oral) before moving onto penetration, or take penetration off the table completely – it’s not a requirement!
You can explore and locate the cervix with your fingers, to get an idea of where exactly the cervix is (it feels like a round bump with a dip in the middle). You can then direct your partners to avoid it when using their own fingers, e.g. by angling upwards, sideways, whatever feels best.
Different sex positions
The Kama Sutra is your friend here! Try new positions that allow you to control the rhythm and depth. Any position with you on top works great. Here are some other sex positions that allow for shallower penetration:
Spooning: Lie on your sides to allow shallower penetration from behind
On your sides facing each other: Lift your leg over their hips, so either one of you can control the rhythm
L shape: Lie on your back, ask your partner to lie sideways at a 90-degree angle and lift your legs over their hips.
Soft doggy: Lie on your front, with your partner stretched out full-length behind you
Shifted missionary: Lie on your back, with one leg between your partner’s, and the other wrapped around the side. This way penetration is shifted to the side slightly and therefore shallower.
You can also use a specially designed wearable like the Ohnut during sex to “customize penetration depth.” It’s a series of soft donut-like rings that can be placed on a shaft to essentially make it shorter.
It may also be helpful to avoid dildos with tapered or pointed ends. Instead, go for rounded ends to avoid pressing too directly on the cervix.
If you do experience pain during sex, you can soothe it like you would period pain – use a hot water bottle or heated pads like Private Packs.
Living With a Tilted Uterus
While a tilted uterus won’t affect your fertility or worsen over time, it can be a difficult thing to live with and cause fear, anxiety or frustration around sex. The more we talk about painful sex conditions, the easier it will be to support those with negative experiences and find new ways to alleviate the discomfort. Everyone deserves a positive sex life, however that looks for them.