“I didn’t know I had a deviated uterus until it affected my sex life. Here’s what I want to tell other women.”

“You know you have a retroverted uterus, right?” the nurse said casually as she examined the grainy black and white image of my transvaginal ultrasound. A generously lubricated wand remained inside me for what felt like a movie length while the nurse scanned my reproductive organs for signs of PMOS.

A retro what? I spent five years in dozens of different doctor’s offices trying to figure out why I started having painful sex at age 21 (not to mention the years of previously routine gynecology exams). But I had never heard of a retroverted uterus, let alone had one.

It turns out I’m in good – if not particularly well-informed – company. About 20 percent of women have a retroverted uterus, says Elizabeth Nakamura. While most uteruses are “anteverted,” meaning they slope forward toward the belly button, the top of my uterus slopes backward toward the spine.

Most people with lopsided uterus are born with the condition due to genetic predisposition. However, after pregnancy or childbirth, you may have a tilted uterus, which can cause the position of the uterus to shift. Certain pelvic conditions such as endometriosis, pelvic inflammatory disease, severely restricted pelvic floor muscles, or scar tissue from surgery can also pull the uterus backwards, says Nakamura.

And even if you’ve spent your life with an erect uterus, there’s no guarantee it will stay that way. According to Nakamura, the whirlwind of changing hormones during menopause, including lower estrogen levels, can weaken your pelvic muscles and ligaments, making them less able to support the original position of your uterus.

How a tilted uterus can affect your sex life

“Although a deviated uterus is common and usually harmless, many people don’t find out they have one until they have a pelvic exam, become pregnant, or experience discomfort during sex,” says Amy Stein. “Conversations about sexual wellness often focus on libido or relationships rather than anatomy, so practical information about pelvic anatomy, pain during intercourse and adjustments is not always part of routine education.” And even when a patient asks a doctor, most aren’t taught how to answer those questions or don’t have resources ready, she says.

However, many women have a perfectly healthy and satisfying sex life with a retroverted uterus. However, if you feel discomfort, pressure, or a dull ache during sex, a tilted uterus could be the reason. “Because the top of your uterus slopes backwards, the passage at the bottom of your uterus — the cervix — protrudes forward,” says Nakamura. “If the cervix is ​​narrow or tender, deep penetration can be painful.”

This pain can be particularly severe during menstruation, when the uterus and cervix descend slightly into the vaginal canal, Nakamura adds. Of course, this depends on a few things, such as the length of your vaginal canal and the size of the toy/penis.

READ MORE: The A to Z of sexual wellness – literally everything you need to know

How to make sex more comfortable with a tilted uterus

The first line of defense for people with a tilted uterus—or anyone who feels uncomfortable with deep penetration—is pelvic floor physical therapy, says Stein. This type of PT can help with restrictions and tension in the pelvic floor muscles, viscera and scar tissue, as well as nerve irritation around the uterus.

A typical pelvic floor physical therapy appointment may consist of strengthening and relaxing the pelvic floor through manual release (also known as pelvic massage therapy), using internal tools such as a pelvic bar, targeted muscle exercises, and breathing exercises. Worth noting: Although these procedures can produce significant changes in pelvic floor function, specific pelvic floor therapy may not be accessible to everyone.

For a DIY option, try these four techniques to relieve pain and increase enjoyment of stone:

1. Experiment with positions

For some people with a tilted uterus, certain sex positions, such as doggy style, can cause intense pressure and discomfort. For this reason, for more comfortable penetration, Stein recommends positions where the receiving partner controls depth and angle, such as: B. Cowgirl or side lying (“spooning”). Even small adjustments can make a big difference in pain relief. For example, the missionary position with a pillow under the hips can help gravity lift the hips, and therefore the low-seated or protruding cervix tilts backwards, making it less likely to be hit during penetration.

Best sex positions for tilted uterus

Illustration by Emily Schiff-Slater

Cowgirl

Here’s how: The receiver sits astride the giver’s pelvis and lowers himself onto his penis or strap-on dildo. From here, the receiver “rides” the giver, bouncing up and down, grinding back and forth, or sliding from side to side – whichever feels best.

Illustration by Emily Schiff-Slater

Spooning

Here’s how: Both partners lie on their sides and face the same direction. The receiving partner bends their knees slightly while the giving partner aligns their pelvis behind them and enters from behind, adjusting the rhythm with gentle thrusts or rocking.

Raised missionary

Here’s how: The receiving partner lies on their back with a regular pillow or a wedge-shaped sex pillow under their hips to elevate the pelvis. Then, like missionary, the giving partner enters and uses the raised angle to adjust depth and rhythm.

2. Use a depth limiting device like the OhNut

OhNut Wearable Sex Aid – Cock Ring Set

Both experts recommend the OhNut, a set of soft, stackable rings worn at the base of a penis or toy to reduce depth of penetration while maintaining intimacy. Many couples find it helpful when deep penetration causes pain.

3. Prioritize arousal and lubrication

Increased arousal naturally lengthens and dilates the vagina (a process called “vaginal tenting”), and lubricants can reduce friction and improve comfort, says Stein.

READ MORE: 3 girl-on-top sex positions that let you control all the action

4. Use pillows for positioning

Experts agree that placing a wedge-shaped sex pillow under the hips or otherwise using a sex pillow to change the angle of penetration can help prevent painful contact with the cervix or vaginal walls.

Ultimately, if you experience pain during penetration due to a tilted uterus, consider this an opportunity to learn more about your body, your well-being, and your pleasure. This doesn’t have to be a barrier to a satisfying sex life, but rather an invitation to find what feels best for your body.

Meet the experts: Elizabeth Nakamura, PT, DPT, OCS, is a physical therapist and owner of Tidal Physical Therapy. Amy Stein, DPT, BCB-PMD, is a pelvic floor physical therapist and author of Heal Pelvic Pain.

This article by Sara Sturek was originally published on Women’s Health US.