What is a uterine septum and vaginal septum?
A uterine septum — or septate uterus — is the most common congenital uterine anomaly. Overall, congenital uterine abnormalities only occur in 4% of people with a uterus. This particular uterine malformation consists of a membrane (septum) dividing the uterine cavity. A septum starts at the top of the uterus (fundus) and may only extend slightly into the uterus (partial uterine septum) or all the way through the cervix and into the vagina (complete septate uterus).
A vaginal septum is another condition that is present from birth. The vagina has a septum dividing the vagina either horizontally or vertically.
A septate uterus is not the same as a bicornuate uterus — a congenital abnormality where the uterus is heart-shaped.
What are septate uterus symptoms?
Some patients never experience side effects from their septate uterus. Others don’t discover their uterine septum until they attempt to become pregnant. Patients with an intrauterine septum have an increased risk of recurrent pregnancy loss, decreased fertility, and preterm delivery.
A uterine spetum may not even be noticeable during a routine pelvic exam! If you’re experiencing infertility or recurrent pregnancy loss, imaging may be part of your diagnostic tests. Hysterosalpingography (HSG) —X-rays of the uterus and fallopian tubes — and ultrasound may show a septate uterus; magnetic resonance imaging (MRI) provides a more detailed image and can help your gynecologist distinguish between an arcuate, bicornate, or septate uterus.
What are septate vagina symptoms?
Symptoms of a septate vagina usually involve pain or discomfort during sexual intercourse and may include unusual menstrual bleeding and pelvic pain.
What is septate uterus surgery?
Uterine septums generally do not cause health problems and may not require any treatment at all. However, if you’re struggling to conceive or experiencing recurrent miscarriages, septum resection surgery can remove the septum and potentially improve your pregnancy outcomes.
Uterine septum surgery (or metroplasty) is an outpatient procedure performed under general anesthesia. You will not be awake for the procedure, but you will be able to go home the same day. We perform uterine septum removal surgery with laparoscopy, although it can also be performed with hysteroscopic surgery or a combination of the two techniques.
What is laparoscopic surgery?
Dr. Aliabai and the Outpatient Hysterectomy Center specialize in laparoscopic surgery. This technique only requires a few small incisions in the abdomen rather than the large abdominal incision required by traditional surgery. The laparoscope — a tiny, lighted camera — is inserted through one of the tiny holes, allowing the surgeon to see what they’re working on. Other long, thin tools are then inserted through the other incisions and the surgeon carefully cuts away and removes the septum.
We also use laparoscopic surgery to treat endometriosis, uterine adhesions, and uterine fibroids — improving patients’ successful pregnancy rates.
What is hysteroscopic metroplasty?
Similar to laparoscopic surgery, hysteroscopy is a minimally-invasive outpatient procedure. However, for hysteroscopic septum resection, the hysteroscope — a thin, lighted camera — is inserted via the vagina and through the cervix into the uterus. With this technique, no incisions are necessary.
Hysteroscopy can be combined with laparoscopic surgery — allowing the surgeon to see inside the uterus while performing surgery through the small abdominal incisions.
How is vaginal septum removal performed?
As with uterine septum resection, you will be under general anesthesia for this procedure. Vaginal septum surgery can be performed without any incisions, as the procedure is performed through the patient’s vagina, not their abdomen.
You will be able to go home the same day.
What is septum surgery recovery time?
Depending on the type of surgery, you should be able to return to work within a day or two following surgery and can expect a full recovery after about two to four weeks. You may experience some abdominal pain after surgery. Some patients find it difficult to sit down comfortably for a few days after surgery. This is normal, but call your doctor if the pain worsens.
You may also experience light spotting for up to one week after the surgery. Use a pad to absorb any blood or discharge. Avoid using tampons and abstain from sex until cleared by your doctor. For optimal recovery, follow all post-operative guidelines given by your doctor and attend all scheduled follow-up appointments.
Call your doctor right away if you experience any symptoms of infection such as:
- nausea
- chills
- fever
- vomiting
Pregnancy after uterine septum removal
You should wait at least two months after surgery before attempting to become pregnant — this allows your uterus ample time to heal.
Studies have presented conflicting reports on the effectiveness of uterine septum surgery to improve a patient’s live birth rate. One retrospective study found hysteroscopic metroplasty decreased patients’ miscarriage rates. A more recent controlled trial determined that uterine septum surgery was not much more successful than expectant management at improving reproductive outcomes.
To determine if septate uterus surgery is the right choice for you, consult with a skilled, trusted OB/GYN — such as Dr. Aliabadi. The effectiveness of surgery will depend on the size and severity of your septum.
Can I have a successful pregnancy with septate uterus?
Is septum removal surgery always necessary? For a vaginal septum, removal surgery will greatly improve your comfort and vaginal function. But if your septate uterus isn’t impacting your health, do you have to have surgery? Are there other options for a successful pregnancy?
Well, it depends on the severity of your septum and how it’s impacting your fertility. Because embryos implant in the top of the uterus, a uterine septum can lead to poor implantation and first- or second-trimester pregnancy loss. Patients with a septate uterus also have a 30% risk of preterm birth.
Because a uterine septum is a physical abnormality in the uterus, it cannot be bypassed with in vitro fertilization (IVF). While IVF can improve your odds of fertilization, it cannot circumvent problems with implantation.
Have questions about septate uterus? Make an appointment with Dr. Aliabadi
As one of the nation’s leading OB/GYNs, Dr. Thaïs Aliabadi offers the very best in women’s health and well-being. With her warm, professional healthcare team, Dr. Aliabadi supports women through all phases of life. She fosters a special one-on-one relationship between patient and doctor.
Highly trained and honored by the reproductive medicine community, Dr. Thais Aliabadi is certified by the American Board of Obstetrics and Gynecology and implements the most advanced, state-of-the-art treatment options for septate uterus, endometriosis, and PCOS.
Dr. Aliabadi specializes in up-to-date, minimally invasive surgical techniques, promising her patients shorter recovery times, reduced pain, and the least interruption to their daily lives.
We also invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700 for general inquiries.
If you believe you are experiencing symptoms of, or suffering from Vaginal and Uterine Septum Corrective Surgery, or have questions about it, please see your doctor.
We also invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863- 6700.
References
DeCherney AH, Russell JB, Graebe RA, et al. Resectoscopic management of Mullerian fusion defects. Fertil Steril 1986;45:726–8.
Jansen FW, Vredevoogd CB, van Ulzen K, et al. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 2000;96:266–70.
Messerlian C, Maclagan L, Basso O (2013) Infertility and the risk of adverse pregnancy outcomes: a systematic review and meta-analysis. Hum Reprod 28(1):125–137.
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.