A septum is a tissue barrier that divides an organ into two areas. A vaginal septum is a vaginal anomaly — or abnormality — that causes the vagina to be separated into two canals. Formed during fetal development, this barrier can cause future problems with normal processes of the vagina.
What Causes a Vaginal Septum?
A vaginal septum is congenital — which means it exists at birth. It forms when a fetus is developing in the mother's womb. Vaginal septums occur in about one in every 3,000 to 80,000 infants. There are no known risk factors for this condition.
Female reproductive organs begin to develop at about 6 weeks inside the womb. In normal development, Müllerian ducts fuse together centrally, with some tissue forming the uterus and fallopian tubes. Other tissues form the vaginal walls of a single vaginal canal.
If any kind of mutation happens at this time, it's called a Müllerian anomaly. This can cause a vaginal septum to form. Women with a vaginal septum may have other internal malformations. These can include:
- Skeletal anomalies (bone)
- Renal anomalies (kidney)
- Anorectal anomalies (anus or rectum)
What Are the Types of Vaginal Septums?
Vaginal septums are classified into three types based on shape, thickness, and location.
Longitudinal vaginal septum. This septum runs vertically along the length of the vagina, dividing the vagina into two separate canals. This can usually happen with a normal uterus, and it often does not prevent normal menstrual cycles. Most women with longitudinal vaginal septum will not have symptoms, so a doctor may notice it during a routine pelvic exam.
Transverse vaginal septum. This septum runs horizontally across the width of the vagina. It can be complete, which causes full blockage of the upper vagina, or partial, which can partially block the vagina. With a complete blockage of the vagina, those affected may experience swelling of the upper abdomen, missed menstrual cycles, and pain during sexual intercourse.
Obstructed hemi vagina. A hemi vagina has a septum that blocks and divides half of the vagina. Women usually have a normal menstrual cycle in one half, and blockages on the other. Many also have a didelphic — or double uterus — and extreme menstrual pain.
What Is the Diagnosis and Treatment of Vaginal Septum?
To diagnose a vaginal septum, your doctor will discuss your symptoms and medical history, perform a pelvic exam, and even ask you to get an MRI done.
Women without symptoms like those with a vaginal septum that doesn't block the vagina may not need treatment. But those who have obstructive septums may have issues with sexual intercourse, tampon use, and natural childbirth. They may also have pain.
The most successful way to treat a vaginal septum is the removal of the septal tissue — which is called surgical resection. Your doctor will talk to you about surgical options.
What Are the Types of Surgical Resection for a Vaginal Septum?
The surgical resection type your doctor uses will depend on the kind of vaginal septum you have. Types include:
Resection of a longitudinal vaginal septum. Here, the vagina is divided into two separate canals. Your doctor will remove the septum and all the abnormal tissue around it during resection, leaving the vagina as a single canal.
Resection of a transverse vaginal septum. This kind of resection is a bit more complex, so your doctor may need to do other interventions in advance. For example, if the septum blocks blood drainage during menstruation, your doctor may drain the obstructed blood first and then proceed with the surgical removal of the transverse septal tissue.
Resection of an obstructed hemi vagina. Here, your doctor will remove vaginal septum tissue to construct a single canal and remove menstrual blood blockages.
Vaginal septum surgery is done under general anesthesia in the hospital, and it may take 1-3 hours. Scarring is a risk associated with any of the above resection types.