Vaginal Septum: Symptoms, Types, Causes and Treatment

A vaginal septum is a congenital condition where a thin wall of tissue divides the vaginal canal. While it may sound like a rare anatomical quirk, this condition can have significant effects on a person’s reproductive, sexual, and general health, often remaining undetected until symptoms or complications arise. In this article, we’ll explore the key symptoms, the main types, the causes behind its development, and modern treatment approaches—helping you better understand this intriguing yet important aspect of gynecological health.

Symptoms of Vaginal Septum

Discovering a vaginal septum can be surprising, as the symptoms often vary from person to person and depend heavily on the septum’s type, location, and whether it causes an obstruction. Some individuals remain asymptomatic, while others experience distressing or even urgent symptoms—especially during adolescence or adulthood. Recognizing the signs early is vital for timely intervention and improved quality of life.

Symptom	Description	Associated Features	Source(s)
Dysmenorrhea	Painful menstrual cramps	May worsen after menarche	1 5 7 8
Abdominal pain	Lower abdominal or pelvic pain	Often cyclic; can be severe	1 5 6 7
Amenorrhea	Absence of menstruation	Often primary; may be cyclic pain	5 7
Dyspareunia	Painful intercourse	Especially with longitudinal septum	2 4 8 11
Difficult Defecation/Urination	Bowel or urinary difficulties	Mass effect from hematocolpos	1
Vaginal discharge	Abnormal, foul, or mucopurulent discharge	Infection or retained secretions	1 10
Infertility/Pregnancy Loss	Difficulty conceiving or carrying pregnancy	Associated with uterine anomalies	8

Table 1: Key Symptoms

Common Presentations

Most commonly, a vaginal septum presents with symptoms at puberty. Dysmenorrhea (painful periods) and cyclic lower abdominal pain are frequent, especially if menstrual blood cannot exit due to an obstructing septum. In some cases, a mass (hematocolpos or hematometra) may be felt in the lower abdomen, resulting from accumulated blood above the blockage 5 7. Amenorrhea—complete absence of periods or primary amenorrhea—may also be a clue, particularly if combined with pain 5 7.

Sexual and Reproductive Symptoms

Longitudinal vaginal septa, particularly when partial, may not obstruct menstrual flow but can cause dyspareunia (painful intercourse) and sometimes difficulty with tampon use or penetrative sexual activity 2 4 8 11. In some cases, recurrent vaginal infections or abnormal discharge may be the first sign, especially in women with an incomplete septum 10.

Unusual and Systemic Symptoms

Rarely, the mass effect from a distended vagina or uterus (hematocolpos, hematometra) can compress nearby organs, leading to difficulty with urination or defecation, as seen in specific case reports 1. Additionally, some patients experience infertility or repeated pregnancy losses, especially when vaginal septa coexist with uterine anomalies 8.

When to Seek Help

If you or someone you know experiences any of the above symptoms, especially around puberty or after starting periods, seeking prompt gynecological evaluation is important. Imaging such as ultrasound or MRI can help confirm the diagnosis and guide management 7.

Types of Vaginal Septum

Vaginal septa are not all the same. Their classification is based on their orientation and completeness, each with distinct clinical implications. Understanding these types is crucial for diagnosis and treatment planning.

Type	Description	Typical Associations	Source(s)
Longitudinal	Vertical wall dividing the vagina lengthwise	Uterine anomalies, didelphys	2 4 8 10 11
Transverse	Horizontal wall across the vagina	Hematocolpos, cervical agenesis	3 5 6 7
Oblique	Slanting septum, usually associated with OHVIRA	Renal agenesis, uterus didelphys	1 9
Partial	Incomplete division, not reaching across vagina	Fewer symptoms, less obstructive	2 4
Complete	Full division across vagina	Higher risk of obstruction	2 4 5 8

Table 2: Types of Vaginal Septum

Longitudinal Vaginal Septum

A longitudinal vaginal septum (LVS) is a vertical partition that splits the vaginal canal into two halves. It can be partial or complete, and is frequently associated with uterine anomalies like uterus didelphys (double uterus) or a septate uterus 2 4 8. Depending on its size and location, it may cause symptoms like painful intercourse, difficulty with tampon insertion, or even labor complications 2 4. Classification systems now consider aspects like completeness (partial vs. complete), symmetry (left/right dominance), and cervical association 4.

Transverse Vaginal Septum

A transverse vaginal septum (TVS) is a horizontal wall that runs across the vaginal canal, usually resulting from incomplete fusion of the Müllerian ducts and urogenital sinus during development 3 5 6 7. The septum may be thin or thick and can be located at any level—though most commonly at the upper or mid-vagina 5. A complete transverse septum typically causes obstructed menstrual flow, leading to hematocolpos and cyclic pain in adolescents 5 7. Partial transverse septa may allow some flow but still cause issues.

Oblique Vaginal Septum

Oblique vaginal septum is less common and often occurs as part of the Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) syndrome, also known as Herlyn-Werner-Wunderlich syndrome 1 9. It typically coexists with uterus didelphys and the absence of one kidney, and can present with atypical symptoms, including bowel and urinary difficulties due to mass effect 1.

Partial vs. Complete Septa

Both longitudinal and transverse septa can be partial or complete. Partial septa may not cause significant obstruction, leading to milder or even absent symptoms. Complete septa tend to cause more pronounced symptoms due to blockage of menstrual flow, leading to pain, amenorrhea, and mass formation 2 4 5 8.

Causes of Vaginal Septum

Understanding why vaginal septa form takes us back to the intricacies of embryological development. While most cases are congenital and result from errors in the formation or fusion of key structures in the developing female reproductive tract, the underlying mechanisms can differ based on the septum type.

Cause	Mechanism/Origin	Related Conditions	Source(s)
Müllerian duct fusion failure	Incomplete merging of ducts	Transverse septum, uterine anomalies	3 5 7
Müllerian duct canalization defect	Incomplete canalization (hollowing out)	Transverse septum	5 7
Persistent urogenital sinus tissue	Failure of tissue resorption	Transverse septum	3 5 7
Duplication anomalies	Formation of duplications (e.g., double uterus/vagina)	Longitudinal septum	2 4 8 11
Genetic factors	Underlying genetic predisposition	Often sporadic, sometimes familial	4 8
Syndromic associations	Coexistence with renal and uterine anomalies	OHVIRA syndrome	1 9

Table 3: Causes of Vaginal Septum

Embryological Development and Errors

The female reproductive tract forms from paired Müllerian ducts, which fuse and then canalize (hollow out) to create the uterus, cervix, and upper two-thirds of the vagina. The lower vagina develops from the urogenital sinus. Errors in either the fusion or canalization of these structures can lead to septum formation 3 5 7.

• Longitudinal septa typically result from duplication anomalies—failure of duct fusion leads to double structures (uterus didelphys, double vagina), with a septum dividing the vaginal canal 2 4 8 11.
• Transverse septa occur when there is incomplete fusion between the Müllerian ducts and the urogenital sinus, or when the canalization process is incomplete, resulting in a horizontal barrier 3 5 7.

Genetic and Syndromic Factors

Most vaginal septa occur sporadically, but some familial cases and genetic predispositions have been observed 4 8. Importantly, vaginal septa often coexist with anomalies of the uterus and kidneys, as these organs develop from related embryological structures. For example, OHVIRA syndrome features an oblique septum, double uterus, and ipsilateral renal agenesis 1 9.

Associated Anomalies

Due to their shared embryological origins, vaginal septa are frequently associated with:

• Uterine anomalies (didelphys, bicornuate, or septate uterus)
• Renal anomalies (unilateral renal agenesis)
• Cervical agenesis or atresia 1 2 4 5 9

Treatment of Vaginal Septum

Treatment for vaginal septum is highly individualized and depends on the type, location, symptoms, and associated anomalies. The mainstay of therapy is surgical, with modern advances focusing on minimally invasive, fertility-sparing, and patient-centered approaches.

Treatment	Description/Technique	Key Outcomes/Benefits	Source(s)
Surgical excision	Removal of septum via surgery	Relief of obstruction, improved symptoms	3 4 5 6 7 8 9 10 11
Hysteroscopic/vaginoscopic resection	Endoscopic removal via hysteroscope	Minimally invasive, preserves anatomy	4 9 10 11
Laparoscopic assistance	Surgical support to address complex anatomy	Useful in severe/associated anomalies	1 6 7
Drainage of hematocolpos	Evacuation of retained blood	Immediate pain relief	5 7
Postoperative vaginal dilation	Prevents restenosis after surgery	Maintains vaginal patency	6
Symptom management	Pain relief, antibiotics for infection	Supportive care as needed	1 10

Table 4: Treatment Modalities

Surgical Excision

The main goal of treatment is to remove the septum, restore normal vaginal anatomy, and relieve obstruction. Surgical excision is the standard, whether performed through the vagina, with endoscopic guidance, or with laparoscopic assistance in complex cases 3 4 5 6 7 8 9 10 11.

• Longitudinal septa: These are usually resected via the vaginal route or using hysteroscopic techniques. Complete resection can resolve dyspareunia, dysmenorrhea, and reproductive complications 4 8 10 11.
• Transverse septa: Require careful excision, often with drainage of accumulated blood (hematocolpos). In some cases, laparoscopic guidance is used to address coexisting uterine or renal anomalies 6 7.

Minimally Invasive and Office-Based Approaches

Recent advances allow for minimally invasive treatment, especially in patients where preservation of the hymen or avoidance of trauma is important. Hysteroscopic (endoscopic) resection, sometimes referred to as the "vaginal septum as uterine septum" approach, provides excellent outcomes with minimal discomfort and a low risk of complications 4 10 11. Office-based procedures with small hysteroscopes are increasingly used for isolated septa 10.

Management of Associated Complications

Drainage of hematocolpos or hematometra is often required in obstructed cases, providing rapid relief of pain and preventing further complications 5 7. In cases of infection or retained discharge, antibiotics and supportive care are provided 1 10.

Postoperative Care and Prognosis

Postoperative vaginal dilation may be advised to prevent restenosis (re-closure), especially in younger patients or after thick septum excision 6. Most women experience significant relief of symptoms and improved sexual and reproductive outcomes after surgery 4 8 11. Fertility and pregnancy outcomes are generally favorable, but some increased risk of miscarriage or preterm delivery may persist, particularly if there are associated uterine anomalies 8.

Conclusion

Vaginal septum is a rare but important congenital anomaly that can significantly impact reproductive, sexual, and general health. Early recognition and individualized management are essential for optimal outcomes.

Key Takeaways:

• Vaginal septum can present with varied symptoms: pain, amenorrhea, dyspareunia, abnormal discharge, and, rarely, bowel or urinary difficulties.
• Main types include longitudinal, transverse, and oblique septa, with further classification by completeness and associated anomalies.
• Causes are rooted in embryological development errors—especially in Müllerian duct fusion, canalization, and resorption.
• Treatment is primarily surgical, with modern, minimally invasive techniques offering excellent outcomes. Postoperative care is key to preventing recurrence and optimizing function.
• Associated uterine and renal anomalies are common; multidisciplinary care may be needed.

Understanding the spectrum of vaginal septum—its types, causes, symptoms, and treatments—empowers patients and clinicians alike to ensure timely diagnosis and compassionate, effective care.