This information leaflet is about transverse vaginal septums.
This leaflet will describe what having a transverse vaginal septum means, how it can affect you, and what are the treatment options.
Transverse vaginal septum: thin and mid-level
What is a transverse vaginal septum?
A septum is a piece of extra tissue in the vagina. A transverse septum means the tissue stretches across the middle of the vagina, separating the upper and lower vagina.
A septum may have a hole in it (perforate) or it may not have a hole in it (imperforate). If there is no hole in the septum then period blood will not be able to flow out of the body (menstrual obstruction).
Transverse vaginal septum: thin, mid-level and perforate
The level of a septum can also be different, some are high (nearer the womb) and some are low (nearer the vulva). How thick and how high a transverse septum is can affect the options for management.
Transverse vaginal septum: thin and low-level
Transverse vaginal septum: thick and mid-level
Transverse vaginal septum: thin and high-level
Your doctor will arrange for an MRI scan to better assess the type of transverse septum you are affected by so they can best plan how to treat you.
If a transverse vaginal septum leads to an obstruction, with period blood building up each month, it will lead to increasing lower abdominal (tummy) pain. Sometimes there may also be a lump (mass) in the lower abdomen.
Sometimes the obstruction can also cause difficulties with weeing or can lead to constipation.
If periods have been obstructed for a long time, it can increase the risk of a condition called endometriosis (when cells like the lining of the womb (endometrium) are found elsewhere). Endometriosis can make periods more painful, cause internal scarring and can lead to fertility problems later in life, even after an operation to relieve the cause of the obstruction.
If the septum has a small opening (perforate) there may initially be no symptoms, although sometimes periods can last longer as blood takes longer to come out of a smaller opening.
A transverse vaginal septum can also affect vaginal sex.
The vagina develops before birth during the early stages of pregnancy.
The vagina and womb are made by a pair of tubes (Mullerian ducts) which fuse together.
A transverse vaginal septum is formed when the lower sections of these tubes don't follow typical development.
A transverse vaginal septum may also be associated with a difference in womb development. Your doctor will have arranged a scan to look for this and will explain if and how this affects you.
Some people with a transverse vaginal septum may also have kidneys that have developed differently. Your doctor will arrange a kidney ultrasound to check this if you haven’t already had one.
Whilst we get the reports of your scans, you will be prescribed hormone medicines to stop your periods. This will help with the pain and discomfort from obstructed periods.
If you have a thin transverse vaginal septum then the team will recommend surgery to remove the septum.
If you don’t have surgery, we will recommend continuing on hormonal medications long-term to prevent further build up of obstructed period blood.
Obstructed periods can lead to increasing pain and endometriosis. This can cause pain, and may also affect someone’s fertility and kidney function.
If you have a thick transverse vaginal septum then further investigations may be needed to understand your treatment options. The team will recommend staying on hormones to stop your periods. These hormones can be continued until a plan has been made with you.
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 team may use an ultrasound scan in theatre to help guide the procedure. This is typically over your lower tummy but occasionally a small ultrasound scan probe is used in the rectum (back passage).
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 surgery is performed vaginally (no planned cuts on your tummy). This involves placing your legs in special stirrups to allow access to the vagina. The septum is removed so the vagina is no longer obstructed.
Once the vaginal septum is removed dissolvable stitches are used to bring the upper and lower vaginal edges together. These stitches dissolve (disappear by themselves) and so do not need to be removed.
At the end of the procedure, before you wake up, a vagina mould will be put into the vagina. This is a small balloon filled with water. It holds the vagina open to help prevent the edges of where the septum has been removed healing together which could lead to narrowing or re-obstruction.
We use temporary stitches to help close the labia and keep the balloon in place in the vagina.
The balloon remains in the vagina for three to five days during which time you will stay in hospital. It is then deflated by draining out the water and is gently removed from the vagina.
Sometimes if someone has a very thin and low septum a mould is not needed.
The surgery typically takes one to two hours. You will wake up in recovery and, after a while, 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.
If no mould was inserted, then we would aim to get you home the same day or the day after. You would be able to go home provided there were no concerns during the surgery, you are feeling well, are able to pass urine, and are eating and drinking.
If the surgical team have needed to place a mould in the vagina at the end of the surgery, then you will wake up with this and a tube (catheter) in your bladder to drain away urine. The urinary catheter is important, as it is difficult to pass urine (wee) with the vaginal balloon in place. The catheter will be taken out when the mould is removed.
You will have some discomfort from the vaginal mould. You will be able to discuss the best options for pain relief with the anaesthetist before your operation.
The surgical and nursing team will help support you with getting out of bed and gently moving around with a vaginal mould.
We will aim to get you home either the same day as your surgery or when we remove the vaginal mould.
You may be given a daily injection to thin your blood during your stay in hospital following your operation. This is to reduce the risk of blood clots forming in the legs and the lungs.
You are likely to have some light vaginal bleeding and discharge for the first couple of weeks after the surgery. It’s common for there to be thick and dark red/brown discharge for the first few days. 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 that can 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).
The surgical team will advise you on when to stop your hormonal medications.
The vagina will need regular dilation after surgery to help it heal without narrowing or re-obstructing. You will have seen the team’s nurse specialist in clinic to understand this and what it will involve.
The nurse specialist will see you after your surgery – when the vaginal mould has been removed – and will help you get started using the vaginal dilators. They will help you make a plan to use the dilators regularly.
Our psychology team can also support you with how you feel about vaginal dilation.
Your team will discuss this with you after the procedure, depending on the operation you had and how you are feeling.
Generally, we recommend one or two weeks off school, college or work. To help with healing we recommend showers rather than baths for the first four 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, how you are finding the vaginal dilatation 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 small risk of bleeding from where the vaginal septum is removed. Uncommonly this will be heavy and require blood transfusion.
Sometimes infection can affect where the vaginal septum has been removed. This may cause increased bleeding. Infections can generally be treated with a week’s course of antibiotic tablets.
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).
To minimise the risk of the vagina re-obstructing (heals closed where septum removed) or narrowing (stenosis) vaginal dilation is recommended. If the vagina re-obstructs or is narrowed then further surgery will be carefully considered with you.
The surgical team will discuss how your uterus and vaginal differences can affect your future fertility and management of any future pregnancies (including whether future vaginal birth would be suitable for you).
Your doctor will consider the benefits and risks of having this surgery with you, and your alternative options.
Our team’s psychologists 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 explain why they have recommended this surgery. 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 have the opportunity to meet the team’s psychologist who can help you with the decision process, and discuss your feelings about the procedure and about using vaginal dilators afterwards.
You will need to sign a consent form for the surgery. If you have had vaginal sex before then 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.