What is the treatment for a double vagina?

Treatment for Double Vagina

The primary treatment for double vagina (uterus didelphys with vaginal septum) is surgical correction through excision of the vaginal septum when the condition causes symptoms or functional problems. 1, 2

Diagnosis and Evaluation

Before proceeding with treatment, proper evaluation is essential:

• Confirm diagnosis with pelvic examination and imaging (ultrasound or MRI)
• Assess for associated anomalies of the urinary tract (present in up to 30% of cases)
• Evaluate for presence of other Müllerian anomalies
• Determine if the condition is causing symptoms:
  • Dyspareunia (painful intercourse)
  • Difficulty with tampon use
  • Menstrual obstruction
  • Recurrent vaginal infections
  • Infertility concerns

Treatment Algorithm

Asymptomatic Patients

• Observation may be appropriate if the patient is asymptomatic
• Regular gynecologic follow-up to monitor for development of symptoms

Symptomatic Patients

1. Surgical excision of vaginal septum:

   • Complete removal of the septum to create a single vaginal canal
   • Can be performed vaginally in most cases
   • Typically an outpatient procedure with minimal blood loss

2. Post-surgical care:

   • Use of vaginal dilators starting 2-4 weeks after surgery to prevent stenosis 3
   • Regular follow-up to ensure proper healing
   • Vaginal moisturizers applied 3-5 times weekly to maintain vaginal health 3

Special Considerations

• For patients with obstructed hemivagina: Urgent surgical intervention is required to prevent complications such as endometriosis, pelvic adhesions, and infertility 2

• For patients with fertility concerns: Additional evaluation of the uterine structure is necessary, as double vagina often occurs with uterus didelphys (double uterus) 4, 5

• For patients with segmental vaginal aplasia: More complex surgical approaches such as dual-force vaginoplasty may be required 6

Post-Treatment Management

• Regular use of vaginal dilators to maintain patency if recommended by the surgeon 3
• Pelvic floor physical therapy may be beneficial for patients experiencing pain or muscle tension 3
• Psychological support for addressing body image concerns or sexual anxiety

Potential Complications

• Vaginal stenosis (narrowing)
• Dyspareunia (painful intercourse)
• Recurrent vaginal infections
• Scarring at the surgical site

Pregnancy Considerations

Women with a history of double vagina (especially with associated uterine anomalies) should receive specialized prenatal care due to:

• Higher risk of malpresentation
• Increased risk of preterm delivery
• Potential for cesarean delivery depending on uterine anatomy 4, 5

Follow-up Care

• Initial follow-up 2-4 weeks after surgery
• Regular gynecologic examinations every 6-12 months to assess healing and function
• Additional follow-up as needed for symptom management

The surgical approach to double vagina has a high success rate with appropriate technique and post-operative care. Most patients experience significant improvement in symptoms and quality of life following treatment.