The Retroverted Uterus and Pelvic Floor Dysfunction: 400 BC to 2025 AD

In 2025, the retroverted uterus will be more formally recognized with a section in the Female Reproductive System Chapter of Gray's Anatomy. This study examines all available publications to develop a detailed history and associations with pelvic floor dysfunction.

Medline and Embase databases extending back indefinitely were searched looking for references on the retroverted uterus or uterine retroversion. The limited number of articles relevant to any specific section prevented the development of specific selection criteria or the construction of tabulation.

From 400 BC to 2025 AD, a total of 308 publications were able to be sourced, of which 50 were pre-1900. Obstetric indications accounted for 116 (37.7%) publications, nearly all incarceration of a retroverted gravid uterus. Gynaecological indications, including conservative and surgical interventions, accounted from 107 (34.7%) publications. Factors relevant to pelvic floor dysfunction, including imaging, diagnosis and prevalence, were generally in the remaining 85 (27.6%) publications.

The retroverted uterus has a long, rich and interesting history, with significant interruptions in reporting. The most relevant classification is anatomical according to the presence or absence of retroversion and whether retroflexion of the uterine fundus is additionally present. Its aetiology is more likely to be developmental, with a limited acquired component. Although there is a familial tendency, genetic studies have been inconclusive. Prevalence is 16-18% (1:6) women, increasing in the presence of pelvic floor dysfunction. The most significant gynaecological association is with uterine/pelvic organ prolapse and some types of vaginal prolapse. The literature has countless case reports of both obstetric (particularly incarceration) and gynaecological episodes of acute urinary retention. Less dramatic, chronic, sometimes cyclical symptoms of voiding and defecatory dysfunction, as well as pelvic pain, have also been recorded in publications. Uterine retroversion is most commonly asymptomatic, requiring no treatment. Symptomatic cases, including a prolapsed retroverted uterus, may, at times, require surgical relief.