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Vaginal Septum

Congenital divided vaginal anomaly developing as a result of mullerian fusion defect.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Vaginal Septum?

Vaginal septum is a congenital divided vaginal anomaly developing as a result of mullerian (paramesonephric) duct fusion or canalization defect; in the embryonic period, mullerian ducts fuse in the midline to form the uterus, cervix, and upper 2/3 vagina, while the lower 1/3 vagina derives from the urogenital sinus. Insufficiency in the fusion or canalization process causes anomaly.

Two main types: Longitudinal vaginal septum (LVS, sagittal septum, divides vagina into right-left, often associated with bicornuate or didelphys uterus, prevalence 1/2000-1/72,000), Transverse vaginal septum (TVS, divides vagina into upper-lower, classified as upper-middle-lower 1/3, often associated with imperforate hymen). The TVS upper segment is most common (46%), middle (40%), lower (14%).

Clinical: prepubertal asymptomatic; puberty: primary amenorrhea (with imperforate septum), cyclic abdominal pain (cryptomenorrhea/hematocolpos accumulation), hematometra, endometriosis, urinary symptoms (urinary obstruction with pelvic mass). With perforated septum: dysmenorrhea, dyspareunia, infertility, recurrent vaginitis, obstructed labor in pregnancy. Diagnosis: pelvic examination, ultrasonography, MRI (gold standard - associated mullerian anomalies). Treatment: surgical septum excision, hymen repair when necessary.

Symptoms

Imperforate septum (TVS): primary amenorrhea + cyclic abdominal pain
Hematocolpos: pelvic mass, urinary retention, constipation
Hematometra: severe lower abdominal pain, secondary amenorrhea
Perforated longitudinal septum: dyspareunia (pain on intercourse)
Tampon difficulty / impossible to insert
Recurrent vaginitis-discharge
Dysmenorrhea (severe menstrual pain)
Infertility, recurrent miscarriage
Pregnancy: obstructed labor, premature labor risk
Vaginal bleeding from accessory horn (didelphys uterus)

Risk Factors

Family history of mullerian anomaly
DES (diethylstilbestrol) intrauterine exposure (less common today)
Genetic syndromes (HWWS - Herlyn-Werner-Wunderlich, McCune-Albright)
Mullerian aplasia/hypoplasia (Mayer-Rokitansky-Küster-Hauser)
Renal anomaly accompaniment (40-65% - especially HWWS)
Vertebral anomalies (Klippel-Feil)
Other congenital anomalies
Genetic predisposition (autosomal-dominant transmission rare)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Primary amenorrhea after age 15 + cyclic abdominal pain (TVS)
  • Adolescent severe pelvic pain + tense lower abdominal mass
  • Difficulty/impossible tampon insertion (LVS)
  • Persistent dyspareunia
  • Recurrent unexplained vaginitis-discharge
  • Recurrent pregnancy loss + suspicion of uterine anomaly
  • Suspicious mass on pelvic examination
  • Unilateral vaginal bleeding (HWWS)

Treatment Methods

01
Pelvic examination + speculum (visualizing the septum)
02
Transabdominal-transperineal ultrasonography
03
Pelvic MRI (gold standard - mullerian anomaly mapping)
04
Renal ultrasonography (40-65% renal anomaly)
05
Cystoscopy + IVP (urinary anomaly evaluation)
06
Hysteroscopy + laparoscopy (associated uterine anomaly)
07
Surgical treatment options:
08
- Longitudinal septum: vaginal septum excision (transvaginal)
09
- TVS lower 1/3: simple Z-plasty
10
- TVS middle 1/3: more complex - sometimes vaginoplasty
11
- TVS upper 1/3: high-difficulty - sometimes laparoscopic assistance
12
Hematocolpos: drainage + septum excision
13
Endometriosis treatment (if accompanies)
14
Postoperative vaginal dilator (preventing stenosis)
15
Pregnancy planning: high-risk pregnancy follow-up, cesarean section indication evaluation
16
Genetic counseling (familial syndromes)
17
Long-term follow-up: gynecologic examination, fertility evaluation
18
Psychological support (especially in adolescents)

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.