The retroverted uterus, newly termed an anatomical variant (1), involves the cervix pointing downwards and forwards and the axis of the body of the uterus directed backwards, towards the hollow of the sacrum and away from its “normal” anteverted position overlying the bladder. If angulation of the body (corpus) of the uterus on the cervix, at the level of the isthmus, is more pronounced, the retroverted uterus should additionally be termed “retroflexed” (Figure 1). There has been no study, dating back indefinitely, to assess the impact that the retroverted uterus might have on pelvic floor dysfunction diagnoses.

All available articles or references to the search terms of “retroverted uterus” or “uterine retroversion” in Medline and Embase databases extending back indefinitely were examined, as well as other references on the retroverted uterus derived from those or other sources.

From 400 B.C. (where uterine retroversion was mentioned by Hippocrates and other ancient authors) to 2025 A.D., a total of 308 publications were able to be sourced, of which 50 (16.2%) were published pre -1900. Obstetric themes accounted for 116 (37.7%) publications, nearly all (107 – 34.7%) involving the incarceration of a retroverted gravid uterus. Gynecological themes including conservative and surgical interventions accounted for 107 (34.7%) publications. Factors relevant to pelvic floor dysfunction including imaging, diagnosis and prevalence were in the remaining 85 (27.6%) publications. The majority of articles (183 – 59.4%) were published since 1986.

The retroverted uterus is common with a prevalence of 16-18% (1:6) women, increasing in urogynecological patients, i.e. in the presence of symptoms of pelvic floor dysfunction ( prevalence 24%-34%). Transvaginal ultrasound (empty bladder) provides the most diagnostic accuracy.

The retroverted uterus has a long, rich and interesting history with significant interruptions in reporting. Its aetiology is more likely to be developmental with a limited acquired component. Whilst there is a familial tendency, genetic studies have been inconclusive.

The most significant pelvic floor dysfunction association is with pelvic organ prolapse - uterine (up to 4.5 fold increased prevalence) and some types of vaginal prolapse (up to 2 fold increase) (2). The likely pathogenesis is the near parallel axes of the vagina and the retroverted uterus - “intra-abdominal pressure can exert a piston-like action on the retroverted uterus driving it down the vagina”. In contrast, the anteverted uterus would be forced infero-posteriorly, receiving support from the rectum (3)”.  

The literature review revealed case reports of voiding dysfunction involving both obstetric cases (particularly incarceration of the retroverted, gravid uterus) and gynecological episodes of acute urinary retention. Less dramatic chronic, sometimes cyclical symptoms of voiding and defecatory dysfunction have been recorded. A congested (heavier) premenstrual retroverted uterus can increase cervical pressure on the bladder and uterine fundal pressure on the bowel. Despite this, large studies have shown no consistent relationship between the retroverted uterus and the pelvic floor dysfunction diagnosis of voiding dysfunction.

Other large studies have shown no significant relationships with other “most common” urodynamic/pelvic floor dysfunction diagnoses including: (i) urodynamic stress incontinence (USI); (ii) detrusor overactivity (DO); (iii) bladder oversensitivity and (iv) recurrent urinary tract infections (UTI).

The most significant gynecological association of the retroverted uterus is with pelvic organ prolapse - uterine and some types of vaginal prolapse. There is no direct significant relationship with other “most common” urodynamic/pelvic floor diagnoses.

The retroverted uterus has a long, rich and interesting history dating back millennia. General interest  in this entity appears to have increased over the last 40 years, Obstetric scenarios predominate. It is a significant anatomical consideration in the development of pelvic organ (mainly uterine) prolapse. There are no conclusive relationships with other pelvic floor dysfunction diagnoses.

2023 (Pub 2025) Female Reproductive System. Chapter 78 Gray’s Anatomy 43rd Ed. Philadelphia. Elsevier
(2007) A standardized ultrasonic diagnosis and an accurate prevalence for the retroverted uterus in general gynaecology patients. Aust NZ Obstet Gynaecol, 47:326-328.
(1982) Relaxation of pelvic supports. In: Benson RC (ed) Current obstetrics and gynecological diagnosis and treatment. Los Altos. Lange Medical Publications. Chapter 12, pp 285-291.