What is a vaginal septum?
A vaginal septum is an anomaly of the vagina that is congenital, meaning that it exists at birth. This anomaly forms in the reproductive tract during fetal development, while the baby is being formed in the mother's womb.
A septum is a partition that divides two chambers. Having a vaginal septum means that a partition of tissue has formed during fetal development that divides the vagina into two parts. This partition can interfere with menstruation, sexual function and childbirth.
Vaginal septa are categorized based on the way the septum has formed and how it is positioned. We use the following terms to describe different formations of vaginal septa: transverse or longitudinal (whether the septum runs across the vagina or lengthwise), obstructive or non-obstructive (whether the septum blocks menstrual flow), high or low (the septum's positioning in the vagina), and thin or thick (the thickness of the septal tissue).
- Longitudinal vaginal septum – The septum runs along the length of the vagina and essentially divides the vagina into two canals. This type of septum does not block menstrual outflow.
- Obstructed hemi vagina – The septum partially divides and blocks half of the vagina. This is almost always associated with a didelphys (double) uterus and a renal (kidney-related) anomaly on the same side of the block. Girls with this type of vaginal anomaly will have normal menstruation on one side and menstrual obstruction on the other side.
- Transverse vaginal septum – The septum runs across the width of the vagina and can be located at low, middle or high positions.
- A complete transverse vaginal septum blocks the vagina, which obstructs the menstrual outflow.
- A perforated transverse vaginal septum only partially blocks the vagina and contains an opening that allows passage of menses.
What causes a vaginal septum?
Doctors don't completely understand the cause of vaginal anomalies. They are considered multifactorial, which means they are likely caused by defects in multiple genes, with some influence from factors in our environment.
The reproductive organs of a female begin developing around six weeks gestation (six weeks after conception) inside the mother's womb, or uterus. This occurs when two Müllerian ducts slowly migrate toward each other in the fetus and then fuse together in the middle. Some of the tissue migrates upwards to form the uterus and fallopian tubes and the remaining tissue migrates downwards to form part of the vagina. The Müllerian ducts fuse with the vaginal plate, which then forms a vaginal canal. Any disruption to this process may result in a malformation of the uterus or vagina. These types of malformations are known as Müllerian anomalies.
Who gets a vaginal septum?
A vaginal septum is a congenital anomaly that can happen to any woman. Doctors have not identified any specific risk factors that cause this condition. Vaginal anomalies can be isolated or can occur in association with other anomalies including renal anomalies, skeletal anomalies or anorectal malformations, which are anomalies that relate to the anus or rectum.
What are the signs and symptoms of a vaginal septum?
- Longitudinal vaginal septum – Some girls with this type of septum will have a normal uterus, however the majority will also have a Müllerian anomaly such as a septate uterus or didelphic uterus. Patients with a longitudinal vaginal septum will have normal menstruation (periods), however may report difficulty using tampons or experience pain during intercourse. Sometimes women don't experience any symptoms, and their doctor discovers a vaginal septum during a routine pelvic examination.
- Transverse vaginal septum – In the case of a complete transverse vaginal septum, menstrual blood flow is blocked and causes the upper vagina and uterus to swell. Patients with this type of anomaly have absent menstruation (missed periods), worsening cyclic pelvic pain, and sometimes an abdominal mass, which is the uterus filled with blood. Patients might not experience any symptoms when a transverse vaginal septum is perforated. Alternatively, they may have difficulty using tampons and may experience painful intercourse.
- Obstructed hemi vagina – An obstructed hemi vagina is almost always associated with a didelphic uterus and a renal anomaly on the same side of the obstruction. Girls with this type of septum have normal menstruation, but experience worsening cyclic pelvic pain.
What tests are used to diagnose a vaginal septum?
At Children's Hospital Colorado, we diagnose a vaginal septum by performing both a pelvic examination and imaging tests using a 3-dimensional ultrasound or a magnetic resonant imaging (MRI) machine. Ultrasound imaging uses sound waves to create images of the inside of the abdomen and pelvis, while the MRI uses magnets to create images of internal structures and organs. Sometimes, a vaginal septum is associated with malformations of the skeletal system or the urinary tract, so additional X-rays and imaging of the kidneys may also be necessary.
The internal pelvic examination is a full physical exam of the pelvic structures. We recommend performing this exam while the patient is asleep under anesthesia to minimize any discomfort.
Why choose us for these imaging tests?
Vaginal septa are uncommon, and making a correct diagnosis is necessary before considering surgery. Given the rarity of these conditions, it is important that the radiologist is familiar with these malformations, which is why it is important to visit a hospital with an experienced radiology team.
Because Children's Colorado is a regional referral center for vaginal septa, our radiologists have the training and experience necessary to accurately diagnose these conditions.
How do we make a diagnosis for the uterine anomaly?
Once the imaging tests are complete, your physician will review this information along with the clinical history and pelvic examination to make a diagnosis.
How is a vaginal septum treated?
Surgical resection, or removal of the septal tissue, is the most definitive way to manage complications associated with a vaginal septum. However, the timing of surgery depends on the symptoms and characteristics of the septum. Women who don't show symptoms, usually those with non-obstructing septa, may not necessarily need intervention. But it is important to note that these septa can interfere with tampon use, intercourse, and childbirth, so surgery can be performed later to allow for comfortable tampon use, intercourse and safe vaginal delivery of a baby. See the types of vaginal septum resection we perform.
Why choose us for treatment of a vaginal septum?
Vaginal septa are uncommon conditions and they require management by an experienced multidisciplinary care team. Our team includes experts from radiology and psychology, as well as surgical specialists from gynecology, urology, pediatric surgery and colorectal surgery.
At Children's Colorado, we have the experience managing complex conditions and the team to optimize the surgical outcome and well-being of our patients. Because we are part of the Pediatric and Adolescent Gynecology Department, we understand that a lot of work we do is sensitive, especially when dealing with adolescent and teen girls experiencing physical and emotional changes in their lives. That's why we team up with pediatric psychologists to provide necessary emotional support for our patients: because the psychosocial well-being of our patients is just as important as their physical well-being.