Endometriosis UK
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Titled Uterus?

Hi, currently going through the process for finding out if I have endometriosis. I had my ultrascan the other day, to which they announced I had a titled uterus. Didn't know too much about this, so when I got home I did a bit of research. I'm still getting put forward for surgery but they couldn't see too much of what they were looking for (chocolate cysts) on the ultrascan or at least that's what they told me. In anyone's experience is sort of a definitely that if I have this titled uterus I got this endometriosis or is this titled uterus what is causing me all this pain and issues?!

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Hi lozmck12! :)

From what my Gynae has told me! Endo can move your uterus and cause it to tilt backwards - Retroverted. Mine was, which was one of the reasons Endo was suspected. But when I had a Lap it turned out that although I have Extensive Endo my Womb is Retroverted naturally which a low percentage of Women (can't remember? %) have.

Also I think ultrsasound only really shows Cysts so not growths of Endo or Adhesions?

Take Care xx

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Ah right, so from what I can gather it could be either or. I won't know until they have the surgery.

Yeah they were only looking for the cysts. I got asked to do the internal scan but it was far too painful for me at this moment. Hope things get sorted soon. Driving me mad. Xx


About 10% or more women have endo.

1/3rd of all women have naturally tilted uterus or retroverted uterus, which is a huge number of women. Almost all medical illustrations draw the normal forward tilting uterus.

In women with endo - it is unknown how many have a tilted uterus before they get endo, versus how many had endo before their uterus tilted, but the fact is if you have endo you are more likely to have a tilted uterus. Ages ago we did a non-scientific poll and most of us had a tilted womb.

The only time this is of significance is when you have an ultrasound scan - you need to inform the scanner person that you need an internal scan called a Transvaginal Ultrasound every time.

Without a TVUS it is very hard for the ultrasound equipment to see what needs to be seen.

The bonus of this is you do not need to have a full to bursting bladder for the scan.

Opposite in fact - you need an empty bladder which is so much more comfy.

And the whole process is a lot less messy on the clothes too, as all the lube is on the end of the skinny probe that is inserted up the vagina. Some hospitals do still use dildo size probes, but they are not much worse than putting a tampon in, the skinny ones with a blob on the end of a straw in shape, are the best ones to get.

The other times you need to know and mention it, are when you have a smear test. Speculums which they use to open up the vagina so they can see the cervix are usually designed for the forward tilt... there are specially designed ones for use with a retroverted uterus so you need to ask the nurse to use those as they re supposed to be less painful. In my experience all smear tests are agony regardless of the speculum shape used...but in theory it should be less painful with the right shaped gadget for your anatomy.

A normal healthy uterus can flip both ways and will do so. It will have a preference to flip one way over the other, pot luck which one that is, but a doctor can manipulate it to tilt the opposite way though it may not stay put for long.

When youhave endo, it causes scarring and adhesions to grow. these are strands of super glue strong protective tissue that can stick your organs together by accident.

It is adhesions that will cause a uterus to get totally stuck either forward ormuchmorecommonly backwards sticking it to the bowel.

Behind the uterus is apocket. When the uterus is tilted forwards this is a big pocket and thelowest point or cavity inside the pelvis where endo bleeding will collect due to gravity. It is called thePOD or pouch of douglas.

The pod can fill up with old endo blood that cannot escape, it forms a sticky mass that can dent in to the backwall of the vagina and/or dent in to the bowel making having a poo painful and difficult because of the obstruction. Like someone standing on a hose pipe will prevent the water passing so easily and you end up with a trickle getting through.

When you have endo growing down in the pod and adhesions forming the pod can close over with adhesions trapping the old blood mass in the pod. This is called recto-vaginal endo orRV endo

which is complex surgery for an expert endo surgeon and may require the assistance of an endo expert colorectal surgeon as well as the endo gynaecology surgeon.

The pod is also a great place for ovaries to accidentally get trapped in the web of sticky adhesions when they too should have some freedom of movement and operation, also ovarian cysts can get stuck in the POD too.

You also have a pocket or pouch at the front of the uterus - much smaller than the pod and shallower too between the uterus and your bladder and this is the most common location for endo trouble on the bladder.

gynsurgery.org/ols/uploads/... is an illustration- the dark blob isblood pooled in the POD space and denting in the to bowel

now compare that with illustrations without endo complications showing the retroverted uterus motherrisingbirth.com/wp-co...

a naturally retroverted uterus would soon trap anything caught behind it. If it was stuck that way with adhesions the problems are more difficult to sort out.

also spot the cervix position in the two pics.

In the normal image the vagina is longer and the cervix ispushed out of the way when you have sex, but in the retroverted image the vagina isshorter and the cervix is dead ahead and right in the way of incoming penis, so if youhave cervical erosion or adhesions of the cervix or any other problems that cause pain - having sex will mean that fragile cervix is directly in the firing line and will probably cause you to experience painful sex. Your partner won't notice but you will.

Because of that repositioning it is recommended that ladies who do experience sexpain in the missionary position alter their body position during sex which may be less uncomfy.

It does depend on what damage had already taken place from heavy periods or the endo as to how effective that will be at relieving sex pain.

The advice is girl on top- facing his toes, or doggy style if you prefer. But that's upto individual preference.

The main times to be aware of it are smear tests or any vaginal procedures using speculums and also every time you have an ultrasound - it needs to be transvaginal US.

side from that you shouldn't need to think about it.

Only 2/3 of women have a forward tilter- but just about every illustration uses that model. It's very very annoying when trying to describe what's going on in most endo ladies when so many of us have a retroverted uterus, but the endo pics always use the forward tilting version.


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