Exploring the connection between retroverted uterus and pelvic organ prolapse
IUGA Academy. Hutchinson-Colas J. Jun 30, 2018; 213064; 440 Topic: Pelvic Organ Prolapse
Juana Hutchinson-Colas
Juana Hutchinson-Colas

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Exploring the connection between retroverted uterus and pelvic organ prolapse

Suh, C1; Amirahmadi, R1; Lu, C1; Olweny, E1; Yeung, P1;Hutchinson-Colas, J1

1: Rutgers Robert Wood Johnson Medical School

Introduction: There are many known risk factors for the development of pelvic organ prolapse (POP), although the exact molecular mechanism remains poorly understood. Patients with POP are disproportionately likely to have retroverted as opposed to anteverted uteri1, which leads us to hypothesize a connection between retroverted uterus (RVU) and POP. We investigated herein the correlation between uterine orientation and prolapse symptoms and the association between RVU and single nucleotide polymorphism (SNP) markers for POP.

Objective: We hypothesized that uterine retroversion, a risk factor for POP, may be the mechanism by which genetic predisposition to POP is manifested. In order to establish a genetic connection, our working hypothesis is that the frequencies of the POP-associated SNPs will differentiate women with retroverted uteri from those with anteverted uteri. Genetic connection between POP and RVU can be further examined by the prevalence of the POP-associated SNPs in different race and ethnicity groups.

Methods: This study was IRB-approved. Subjects visiting a urogynecology clinic for various reasons were recruited to fill out a simple demographic questionnaire (race, age, gravidity, self-reported POP symptoms, family history of POP, self-identified RVU and known family history of RVU) and also to provide a DNA sample for SNP genotyping. Sequencing results and demographic information were analyzed with Stata, version 12.

Results: The population we surveyed includes 26 patients with RVU and 17 patients with anteverted uteri (AVU). 9 patients from the RVU cohort reported having prolapse-related issues while none of the patients from the AVU cohort reported prolapse symptoms (p=0.005). Sequencing analysis identified an association between uterine orientation and SNP rs1036819 (p=0.028), a previously-identified genomic marker for POP. However, no association was found between uterine orientation and 4 other POP-related SNP loci (rs1455311, rs430794, rs8027714, rs2236479, as previously reported by Allen-Brady, 2011)2. Analysis with race/ethnicity revealed correlations with rs8027714 (p=0.005) and rs2236479 (p=0.052). However, these two SNPs were not found to be associated with the RVU phenotype.

Conclusions: In our patient cohort, a significant correlation exists between RVU and POP symptoms. We found a race/ethnicity correlation with some of the POP-SNP markers, likely due to the high prevalence of Asian- and African-descent patients in our urogynecology clinic. Exploring the genetic connection between POP and RVU only revealed a limited overlap through rs1036819. Further studies expanding genetic marker-panels for RVU and POP will better test the correlation of the two phenotypes.


  1. Haylen BT. The retroverted uterus: ignored to date but core to prolapse. International urogynecology journal and pelvic floor dysfunction. 2006;17(6):555-558.
  2. Allen-Brady K, Cannon-Albright L, Farnham JM, et al. Identification of six loci associated with pelvic organ prolapse using genome-wide association analysis. Obstetrics and gynecology. 2011;118(6):1345-1353.


Work supported by industry: no.

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