A vaginal septum is a piece of flesh that exists in the vaginal either longways (longitudinal) or sideways (transverse). These septa can go unnoticed, or can cause vaginal blockagespainful sex, impossible tampon use, and difficulties during labour. Septum abnormalities are developed in the womb and therefore are known as congenital (or anatomical) abnormalities.

A septum is a flesh separator of some kind as you would see in the middle of the nostrils.

Transverse (horizontal) vaginal septum

A transverse vaginal septum occurs when a defect in fusion occurs as the vagina is being put together during foetal development, where the Mullerian ducts fuse incorrectly to the urogenital sinus.

This abnormality is estimated to occur to one in 3,000-80,000 women, and is considered the rarest of female urogenital tract congenital abnormalities, but numbers are suitably vague because if the septum doesn’t trap menstrual blood behind it in a complete obstruction, it can go completely unnoticed.

The septum is usually less than one cm in thickness, and is often located in the top section of the vagina, but can be found anywhere in the vagina. These septa are not generally associated with other reproductive abnormalities.

Symptoms of a transverse vaginal septum

The most noticeable problems occur around puberty and menstruation when menstrual blood accumulates behind the blockage (cryptomenorrhea), causing cyclic abdominal pain, problems urinating and back pain. As a newborn, unusual abdominal swelling occurs as vaginal discharge caused by the mother’s pregnancy hormones cannot escape.

Treatments for a transverse vaginal septum

Treatment for a transverse vaginal septum is generally surgery, where it can pretty easily be removed. The surgery is typically very uneventful, reasonably fast, and complications are very, very rare.

Longitudinal (lengthways) vaginal septum – the ‘double vagina’

A longitudinal septum is also termed the ‘double vagina’, and the Mullerian ducts fuse incompletely. This makes the vagina split into two, and is often accompanied by a double cervix, and a uterine septum or double uterus (uterus didelphys). Many women with longitudinal vaginal septa and double organs may go their whole lives without being aware of it. Painful sex (dyspareunia) may occur as a result, in which case surgery on the septum can be performed and the problem is usually solved.

Symptoms of a longitudinal vaginal septum

This condition can be painful during sex or menstruation, and cause uterine bleeding.It is not dangerous to your health, and can go unnoticed in women for a lifetime.

Diagnosis of a longitudinal vaginal septum

MRIs are very useful, and are considered to be the gold standard in diagnosing precisely what’s going on.

Fertility outcomes of a longitudinal vaginal septum

There is a higher risk of blood going ‘backwards’ (retrograde menstruation) due to it being unable to escape. This can result in endometriosis, whereby blood from the uterus escapes into the body cavity via the fallopian tube and attaches to the walls of organs, which can affect fertility.

Women with vaginal septa can have successful pregnancies, however they tend to have slightly worse pregnancy outcomes. Conception can be difficult, and miscarriages are more common with transverse and longitudinal vaginal septum cases, however on the scale of things, those with lower transverse vaginal septa have better conception rates than those with upper or middle transverse septa.

Other problems with carrying a baby to term include early pregnancy loss, premature births, abnormal foetuses and preterm labour. Obstruction can also occur during birth, particularly if the septum has not been discovered. Live birth rates for longitudinal septa sit at 82 per cent and 94 per cent for those with a transverse septum.

Surgical treatments and outcomes for vaginal septa

The septa removal surgery is reasonably straightforward as in, the septum is removed and the bases of the septum are joined together. Your surgeon should be experienced in this surgery, so it would pay to call around hospitals in your area, starting with your largest cities, to see – there will be someone who knows how to do this.

The Atlas of Pelvic Surgery has an excellent set of diagrams that accurately depict the surgery, so take a look if you are interested.

In terms of outcomes, the surgery will keep you in hospital for one or two days (though some women are out the same day), and is healed up in weeks. You are able to have sex again in just a month.

Any surgery comes with risks, and your surgeon will explain these to you. The risks are generally poor healing and scar tissue, nerve damage, and infection. Because the surgery isn’t too invasive, risks can be really minimised, and the benefits will be great – having no pain during sex, being able to use tampons, and have a baby without problems seems worth it.

You really do need to find a good surgeon though, one who has done this before – not just once, either! Having a learner driver operating on your reproductive organs is not recommended under any circumstances (unless an emergency obviously!), because any nerve damage or scarring can ruin your sex life for all of time. There are a lot of nerve endings around that area.

To find the surgeon of your dreams, call hospitals, specialists and gynaecologists – just make a spreadsheet, get a list of everyone practicing in Ireland, and start calling. Someone will know something, and have recommendations, including reception staff at hospitals and gynaecology offices.

Find the person everyone recommends – the medical world is pretty small once you get down to it, and specialists in this type of operation are not going to be found many places. The search should be pretty short, but be thorough and get as many opinions as you need to feel in good hands.