Transverse vaginal septum

Transverse vaginal (transvaginal) septum (TVS) is a type of rare congenital utero-vaginal anomaly (class II under the Rock and Adam classification).

It is rare with a frequency of 1 in 70,000 females.

In the case of a complete septum, patients commonly present with primary amenorrhoea and cyclic pelvic pain.

Rarely diagnosed in neonates or infants unless the obstruction causes significant hydromucocolpos.

Clinical examination of the vulva is normal if the septum is in the middle/upper vagina, if a membrane is visible it will transilluminate unlike an imperforate hymen 5.

It is a type of vertical fusional defect. A transverse vaginal septum be either perforate (incomplete) or imperforate (complete) and results from varying degrees of failure in reabsorption of the tissue between the vaginal plate and the caudal aspect of the fused Mullerian ducts.

The septum is a fibrous membrane of connective tissue with vascular and muscular components, the functional length of the vagina is reduced.

Associations

While it may occur in isolation it is often combined with other mullerian duct anomalies such as uterus didelphys 4.

Location - Position

It can occur at almost any level of the vagina. Reported prevalence in terms of position include 1:

  • superior vagina (~46%)
  • mid-vagina (~40 %)
  • inferior vagina (~14%)
Antenatal ultrasound

The diagnosis may be suggested in utero when there is obstruction causing significant amount of hydrocolpos or mucocolpos

The differential is of congenital absent of the cervix. It is important to identify the cervix on MRI in order to differentiate between a high transverse septum and congenital absence of the cervix. Treatment between the two entities varies with congenital absence requires hysterectomy.

Often a surgical excision of the obstructed septum through a perineal approach is performed.

Abdominal and pelvic anatomy
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Article Information

rID: 15382
Section: Anatomy
Synonyms or Alternate Spellings:
  • Transverse vaginal septum (TVS)
  • Transverse vaginal septa
  • Transverse vaginal septae
  • Transvaginal septum

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