Transverse vaginal (transvaginal) septum (TVS) is a type of rare congenital uterovaginal 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 amenorrhea and cyclic pelvic pain.
Rarely diagnosed in neonates or infants, unless the obstruction causes significant hydromucocolpos.
It is a type of vertical fusion defect. A transverse vaginal septum can be either perforate (incomplete) or imperforate (complete) and results from varying degrees of failure in resorption of the tissue between the vaginal plate and the caudal aspect of the fused Müllerian ducts.
The septum is a fibrous membrane of connective tissue with vascular and muscular components. As a result, the functional length of the vagina is reduced.
It can occur at almost any level of the vagina. Reported prevalence in terms of position include :
- superior vagina (~46%)
- mid-vagina (~40%)
- inferior vagina (~14%)
The diagnosis may be suggested in utero when there is obstruction causing a significant amount of hydrocolpos or mucocolpos.
Treatment and prognosis
Often a surgical excision of the obstructed septum through a perineal approach is performed.
The differential is of congenital absence 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 varies between the two entities, with congenital absence requiring a hysterectomy.