Some women can have anatomical variations described as “two vaginas” or a septate vagina. These rare congenital conditions are present from birth, arising from specific developmental processes during fetal formation. Understanding these uncommon conditions helps clarify the topic.
Understanding the Anatomy
The term “two vaginas” refers to a condition where the vaginal canal is divided by a tissue wall, known as a septum. A longitudinal vaginal septum runs the length of the vagina, creating two separate canals. This condition is also associated with a duplication of the upper reproductive tract, including two cervices and two uteri, called uterus didelphys.
Another type is a transverse vaginal septum, where the tissue wall runs horizontally across the vagina, potentially blocking the canal. While a longitudinal septum results in two distinct vaginal canals, a transverse septum divides one vagina into upper and lower parts.
Developmental Origins
The female reproductive system begins to form around six weeks into fetal development from two structures called Müllerian ducts. Normally, these two ducts migrate towards each other, fuse in the middle, and then the tissue between them resorbs to create a single, hollow uterus, cervix, and the upper part of the vagina.
Conditions like a vaginal septum or uterus didelphys occur when this fusion and resorption process is disrupted. If the Müllerian ducts fail to fuse completely, it can result in a duplicated uterus and cervix, often accompanied by a longitudinal vaginal septum. A transverse vaginal septum forms if the ducts do not properly connect with another developing structure called the urogenital sinus, or if there is incomplete degeneration of tissue, leading to a horizontal blockage.
Symptoms and Diagnosis
Many individuals with these anatomical variations may not experience symptoms, and the condition might remain undetected. Some begin to notice signs around puberty with menstruation onset. Common symptoms for a vaginal septum include painful menstruation, difficulty inserting tampons, or persistent vaginal bleeding despite tampon use, as the tampon may only enter one canal.
Pain or discomfort during sexual activity is another symptom that can lead to discovery. For those with a transverse septum, complete blockage can lead to absent menstrual periods and abdominal or pelvic pain due to blood pooling behind the obstruction. Diagnosis often involves a physical pelvic examination, and imaging techniques like ultrasound or magnetic resonance imaging (MRI) are used to confirm the anomaly.
Daily Life and Reproduction
Living with a vaginal septum or duplicated reproductive organs can present practical considerations. Menstruation may be affected, particularly if a septum obstructs one side, leading to pain or trapped menstrual blood. Sexual activity can also pose challenges, with some individuals experiencing discomfort or difficulty due to the presence of the septum.
Reproductive considerations are a concern for individuals with these conditions. While fertility may not always be impaired, there can be an increased risk of complications during pregnancy. These can include a higher chance of miscarriage, preterm labor, or abnormal fetal positioning, which may necessitate a cesarean section. However, many women with these anatomical variations can successfully carry pregnancies to term and have healthy births, sometimes with careful medical monitoring.
Medical Management and Outlook
Treatment for a vaginal septum is not always necessary, especially if the individual is asymptomatic. However, if symptoms such as pain, menstrual issues, or challenges with sexual activity arise, surgical intervention is often recommended. The most common surgical procedure is a vaginal septum resection, which involves removing the dividing wall of tissue to create a single, unobstructed vaginal canal.
In cases of uterus didelphys, surgery on the uterus itself, known as metroplasty, may be considered, particularly if there is a history of recurrent pregnancy loss. The outlook for individuals with these conditions is positive. With proper diagnosis and appropriate medical management, including surgical correction if needed, most individuals can lead full and healthy lives, often including successful pregnancies and comfortable sexual function.