If you picture the uterus as an organ that is essentially static in the abdomen, think again. The combination of elastic tissue and muscle in the supporting ligaments of the uterus is organised to enable rapid adjustment to the altered position and size of its neighbouring organs, the bladder, bowel and vagina. When the bladder or rectum is full, the uterus moves accordingly. In addition, the uterus lifts out of the way with the entry of the penis into the vagina during sexual intercourse. In this position, the uterus may contract during orgasm. When a woman lies on her back, the uterus hugs the rear of the pelvis; if she rolls onto her stomach, it moves towards her belly button; and when she stands, the uterus drops down a centimetre or two, a movement that is accentuated if she has a prolapse and the ligaments do not provide strong support for the uterus.

Displacement of the uterus also occurs if there is a lump or growth in a neighbouring organ. For example, a lump in the vagina pushes the uterus upwards. On the other hand, if there is a growth in the bowel the uterus is pushed forwards, and in the bladder, backwards. The uterus is also able to rotate around the point where the cervix meets the rest of the body. A forwards rotation is called anteversion, and a backwards rotation, retroversion. Some women find these movements uncomfortable if they occur during sexual activity or when a doctor is examining their uterus to see if its ability to move is restricted in any way. In most cases women are largely unaware of these movements, although they may account for some of the pelvic ‘twinges’ or abdominal pain that is sometimes experienced.

For the uterus to contract successfully—which occurs during menstrual bleeds, childbirth and, in perhaps a third of women, during orgasm — the muscle tissue of the uterus and of the surrounding ligaments must work harmoniously. Women do not have conscious control over these contractions; this is exercised by nerves and hormones. Some aspects of uterine function are under dual control of both hormones and nerves, while others are influenced mainly by one or the other.


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