This information leaflet is about longitudinal vaginal septums.
This leaflet will describe what this means, how it can affect you and treatment options.
Longitudinal vaginal septum with septate uterus
A septum is a piece of extra tissue in the vagina. A longitudinal septum means the tissue runs down the middle and separates the left and right sides of the vagina.
The septum length may vary – it could run the entire length of the vagina or be partial (only at the upper or lower level of the vagina). The septum doesn’t extend outside of the vagina.
The septum can range in thickness but is generally less than one cm thick.
The vagina develops before birth during the early stages of pregnancy.
The vagina and womb (uterus) are made by a pair of tubes (Mullerian ducts) which fuse together.
A longitudinal vaginal septum is formed when the lower sections of these tubes don't follow typical development. Usually this is also associated with a difference in how the womb forms.
Someone with a longitudinal vaginal septum may have either have a double womb (uterine didelphys: two smaller left and right sided wombs) or a single womb with a dividing septum (band of tissue dividing left and right sides of the womb).
Your doctor will have arranged a scan to look at your womb shape and will explain how this might affect you.
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Some people with a longitudinal vaginal septum may also have kidneys that also have developed differently. Your doctor will arrange a kidney ultrasound to check this if you haven’t already had one.
Longitudinal vaginal septum with uterine didelphys
Many people are not affected by having a longitudinal vaginal septum.
People with longitudinal vaginal septums may find that tampons don’t work well for them. Tampons can be difficult to insert and they will still leak period blood as the tampon misses the period blood from the other side of the septum.
A longitudinal vaginal septum may cause discomfort with vaginal sex and sometimes can tear and cause bleeding. It also can tear in pregnancy with labour and vaginal birth. The septum can make speculum examinations more difficult when people are having cervical smears or sexual health tests.
Your doctor will discuss how your uterus and vaginal differences can affect your future fertility and management of any future pregnancies.
If your vaginal septum is affecting you, you can have surgery to remove the septum. If your septum is not affecting you then no surgery is required. However, we might recommend reconsidering the option of surgery before actively trying for a pregnancy as a septum can tear with vaginal birth.
The surgery is carried out in the operating theatre with you asleep (under a general anaesthetic). As you will be asleep with an anaesthetic you will not feel pain. Often an injection into the septum is given after you are asleep to help reduce bleeding and pain after the surgery.
The surgery is performed vaginally and therefore after anaesthetic your legs will be placed in special stirrups to allow access to the vagina. A small tube (urinary catheter) will be passed into your bladder. This will allow for your urine to be drained into a collection bag during the surgery.
The surgical team will remove the septum and they may also use some dissolvable stitches to help healing and bleeding. These dissolve and so do not need to be removed.
The surgery typically takes less than an hour. You will wake up in recovery and after a short while will be transferred back to the ward.
You will have a fine tube in your arm (drip or iv) until you are drinking.
The surgical team will see you afterwards on the ward to let you know how the operation has gone.
Most people can go home the same day of the surgery.
There will be some discomfort from the procedure and the team will recommend what painkillers to take to help your recovery.
You are likely to have some light vaginal bleeding and discharge for the first couple of weeks after the surgery. If you notice fresh bleeding or smelly discharge then please contact the teams’ Clinical Nurse Specialist or your GP. These may be signs of an early infection. This can normally be treated with antibiotic tablets.
If you feel unwell with heavy bleeding, fever, chills, increasing pain or diarrhoea or vomiting you should attend your local A&E for potential admission and antibiotics through a drip (your local team can contact the UCLH team for advice).
Your team will discuss this with you after the procedure, depending on the operation you had and how you are feeling.
Generally, we recommend two weeks off school, college or work. To help with healing we recommend showers rather than baths for the first few weeks after the operation. Most people can use tampons with their second period after the procedure.
A follow up appointment will be arranged for around six to eight weeks after the operation. We will check on how you are feeling after the surgery and advice about vaginal sex.
All operations and anaesthetics carry small risks that your doctor will discuss with you when you sign the consent form.
Risks of this procedure include injury to the neighbouring body parts, such as the urethra (tube that urine leaves the bladder through), bladder and bowel. These are serious but uncommon risks with this operation.
If this happened and was recognised, then it would be repaired during the operation. It is possible that damage to the urethra, bladder, or bowel may cause long-term incontinence (leakage of urine or stools). We may need to perform key-hole surgery with a camera inserted into the bladder (cystoscopy), tummy(laparoscopy) or an open operation (laparotomy) to check or repair an injury.
There is a risk of developing blood clots in the veins of the leg (deep vein thrombosis: DVT) which can travel to the lungs (pulmonary embolism). To reduce this risk, you will have some special socks to wear and you may also need injections to keep your blood thin whilst you are in hospital.
There is a small risk of bleeding from where the vaginal septum is removed but this is uncommon to be heavy and require blood transfusion.
Sometimes infection can affect where the vaginal septum has been removed. This may cause increased bleeding but is generally treated with a week’s course of antibiotic tablets. Infection rarely can cause scarring which can cause narrowing of the vagina.
Occasionally infection may travel up into the womb, fallopian tube and abdomen. This can cause sepsis and the infection could cause damage to fallopian tubes, which could affect future fertility. If you feel unwell with fever, chills, increasing pain or diarrhoea or vomiting you should attend your local A&E. You may need to be admitted for antibiotics through a drip (your local team can contact the UCLH team for advice).
Your doctor will consider the benefits and risks of having this surgery with you and your alternative options.
Our team can help you decide if this operation is the right choice for you. They can also help you consider when would be the right time for you to have this operation.
In clinic your doctor will discuss the option of this surgery with you. They will talk through the procedure, what to expect on the day and recovery from the operation as well as go through the surgical risks.
You will need to sign a consent form for the surgery. If you have previously had vaginal sex, swabs will also be taken from the vagina at your clinic appointment.
A short while before the operation you will need to come to hospital for a pre-operative assessment to have some blood tests and other routine investigations.
On the day of the operation, you will be seen by the surgical and anaesthetic teams on the ward before the operation. You will have the opportunity to ask any questions you may have since your last clinic appointment.