Transverse Vaginal Septum

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Last modified 22/04/2025

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Chapter 88 Transverse Vaginal Septum

INTRODUCTION

Description: A transverse vaginal septum is a partial or complete obstruction of the vagina generally found at the junction of the upper third and lower two thirds of the vaginal canal. The septum is generally less than 1 cm in thickness and may or may not have a small opening to the upper genital tract. (The location and thickness are highly variable.)
Prevalence: One of 72,000 to 75,000 females.
Predominant Age: Present at birth but generally not diagnosed until puberty.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Incomplete canalization of the Müllerian tubercle and sinovaginal bulb.
Risk Factors: Partial septa have been reported in women exposed in utero to diethylstilbestrol (DES).

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Blind, shortened vaginal pouch
• Primary amenorrhea
• Mucocolpos
• Hematocolpos
• Hematometra
• Foul vaginal discharge (with incomplete septum)
• Vaginal/abdominal mass without bulging of the vaginal outlet (hematocolpos and mucocolpos may be associated with urinary tract obstruction if very large)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Vaginal agenesis
• Imperforate hymen

Associated Conditions: Endometriosis, infertility, amenorrhea, hematocolpos, and dyspareunia.

Workup and Evaluation

Laboratory: No evaluation indicated.
Imaging: Ultrasonography may be used to evaluate the presence and condition of the upper genital tract.
Special Tests: None indicated.
Diagnostic Procedures: Pelvic examination.

Pathologic Findings

None.

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation, reassurance.
Specific Measures: Transverse vaginal septa must be excised surgically. When the septum is thick, reconstruction with skin grafts or flaps may be required. In extreme cases, a neovagina must be surgically created. (Once drainage of the upper tract is obtained, vaginal reconstruction may be delayed to a later date.)
Diet: No specific dietary changes indicated.
Activity: No restriction.
Patient Education: Reassurance, education about possible effects on fertility and sexual function (for most patients there will be little or no effect).

Drug(s) of Choice

None.

FOLLOW-UP

Patient Monitoring: Once a normal vaginal canal has been restored, normal health maintenance. Patients must be monitored for narrowing of the vagina at the level of the removed septum or vaginal reanastomosis.
Prevention/Avoidance: None.
Possible Complications: It is rare, but a mucocolpos can cause serious and life-threatening compression of surrounding organs, leading to hydroureter, hydronephrosis, rectal compression and obstruction, restricted diaphragmatic excursion, compression of the vena cava, and cardiorespiratory failure. Fistulae to the urinary tract may occur. Prolonged obstruction of menstrual outflow is associated with the development of endometriosis and pelvic scarring (often extensive); chronic pelvic pain, dyspareunia, and infertility may result. Pregnancy rates for patients with corrected transverse septa range from 25% to 50% based on location of the septum and series report.
Expected Outcome: With timely diagnosis and treatment, the prognosis is good.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy once pregnancy is achieved. Pregnancy success is greatest with septa that are lower in the vagina and repaired early. Based on the extent of vaginal reconstruction performed and the degree of subsequent scarring, cesarean delivery may be elected.
ICD-9-CM Codes: 752.49.

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REFERENCES

Level II

McKusick VA, Weiboecher RG, Gragg GW. Recessive inheritance of a congenital malformation syndrome. JAMA. 1968;204:113.

Rock JA, Zacur HA, Dlugi AM, et al. Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum. Obstet Gynecol. 1982;59:448.

Level III

American College of Obstetricians and Gynecologists. Vaginal agenesis: diagnosis, management, and routine care. ACOG Committee Opinion 355. Obstet Gynecol. 2006;108:1605.

Brenner P, Sedlis A, Cooperman H. Complete imperforate transverse vaginal septum. Obstet Gynecol. 1965;25:135.

Katz VL, Lentz GM. Congenital abnormalities of the female reproductive tract. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:248.

Lilford RJ, Morton K, Dewhurst J. The diagnosis and management of the imperforate vaginal membrane in the pre-pubertal child. Pediatr Adolesc Gynecol. 1983;1:115.

Lopez C, Balogun M, Ganesan R, Olliff JF. MRI of vaginal conditions. Clin Radiol. 2005;60:648.

McKusick VA. Transverse vaginal septum (hydrometrocolpos). Birth Defects. 1971;7:326.

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