A vaginal septum is a structural difference present at birth, classified as a congenital anomaly of the female reproductive tract. This condition involves the presence of tissue that divides the vaginal canal. The septum is not visible externally and its presence may not be known until a person reaches puberty or becomes sexually active, depending on its specific location and size. Because it is a structural issue, a vaginal septum can interfere with normal biological functions like menstruation, sexual activity, and childbirth. This anatomical variation is part of a broader category of formations known as Müllerian anomalies.
Anatomical Origin and Formation
The formation of a vaginal septum is directly related to the complex process of fetal development that creates the internal reproductive organs. The uterus, fallopian tubes, and the upper portion of the vagina all develop from two parallel structures called the Müllerian ducts. These ducts begin to form early in gestation, around the sixth week of pregnancy. For normal development to occur, these two ducts must completely fuse together in the midline, forming a single, continuous uterovaginal canal.
Following the initial fusion, the solid tissue between the ducts must then break down and be reabsorbed in a process called canalization. A vaginal septum forms when this fusion or subsequent reabsorption process is incomplete or fails entirely. The resulting tissue barrier is the remnant of the unfused or unresorbed ductal walls. Since the cause is a developmental error occurring in the womb, there are no known specific risk factors that a person can control.
Categorizing Septa: Transverse and Longitudinal
Vaginal septa are primarily categorized based on the orientation of the dividing tissue within the canal. A transverse vaginal septum runs horizontally, dividing the vagina into two distinct segments, an upper and a lower one. This type of septum can occur at various points along the canal, such as the lower, middle, or upper third of the vagina.
The transverse septum is often described as either complete, meaning it entirely blocks the canal, or perforated, meaning it has a small opening that allows some passage. A longitudinal vaginal septum runs vertically down the length of the canal, separating the vagina into two parallel channels. This vertical division is sometimes referred to as a “double vagina.”
The position and orientation of the septum determine the resulting symptoms and necessary treatment approach. The longitudinal type typically runs along the length of the vagina, rarely creating a complete physical blockage of menstrual flow. In contrast, a complete transverse septum creates an impassable barrier that seals off the upper reproductive tract.
Identifying Manifestations and Diagnosis
The symptoms associated with a vaginal septum vary widely depending on the type and whether it is obstructive. Patients with a complete transverse septum usually present with primary amenorrhea, the absence of a menstrual period by the expected age of menarche. This occurs because menstrual blood, unable to exit the body, accumulates behind the barrier, leading to a condition called hematocolpos. The pooling of blood can cause chronic or cyclical abdominal and pelvic pain, often worsening over time.
Patients with a longitudinal septum or a perforated transverse septum will have menstrual flow but may experience other difficulties. Common complaints include painful intercourse (dyspareunia) due to the presence of the dividing tissue, or difficulty using tampons if one canal is used while the other continues to bleed. Recurrent vaginal infections are sometimes reported with the longitudinal type, as one of the two channels may not drain effectively.
Diagnosis begins with a thorough physical examination, which can often identify the presence and orientation of the septum. To determine the extent and relationship to other pelvic organs, imaging techniques are utilized. A pelvic ultrasound is frequently the first step, providing a clear visualization of the septum and any associated fluid collection. Magnetic Resonance Imaging (MRI) is considered the gold standard, offering detailed, cross-sectional images that confirm the type of septum and rule out other possible reproductive tract anomalies.
Surgical Correction and Long-Term Outlook
The standard treatment for a symptomatic vaginal septum is surgical correction to remove the dividing tissue and restore a single, functional vaginal canal. This procedure, known as a septoplasty or septal excision, is typically a minor operation. For a longitudinal septum, the excess tissue is excised, and the remaining edges are sutured to unify the two canals. With a transverse septum, the obstructing wall is cut, removed, and the upper and lower sections of the vagina are joined together.
The long-term outlook following surgical correction is excellent, with high success rates for restoring normal function. Patients can generally expect normal menstrual cycles, comfortable sexual function, and no limitations on their daily activities. Most individuals who undergo this procedure experience normal fertility, though those with a history of a high transverse septum may require closer monitoring during pregnancy. The removal of the obstructing tissue resolves the mechanical issues, allowing for a healthy reproductive life.