A woman can have two separate vaginas, a rare congenital condition resulting from a disruption during fetal development. This anatomical structure is present at birth and is often a consequence of a larger structural variation in the internal reproductive organs.
Understanding Vaginal Duplication
The presence of two vaginas is typically associated with Uterus Didelphys, meaning “double uterus.” This anomaly involves the complete duplication of the uterus, cervix, and often the vagina. The reproductive tract is essentially divided into two separate, parallel systems instead of a single, central structure.
The two vaginal canals are separated by a wall of tissue known as a longitudinal vaginal septum. This septum runs the length of the vagina, creating two distinct passages. Each vaginal canal leads to its own cervix and its own separate uterine cavity, which is often smaller than a typical uterus.
The Embryological Origin
This duplication traces back to a process in fetal development involving the Müllerian ducts, also called the paramesonephric ducts. In a developing female fetus, these two ducts normally begin to fuse together between the sixth and twelfth week of gestation. This fusion process creates the single uterus, cervix, and upper part of the vagina.
In Uterus Didelphys, the Müllerian ducts fail to fuse completely or remain entirely separate. When fusion does not occur, each duct develops into a separate structure, resulting in two distinct uterine horns, two cervices, and the vaginal septum that forms the two vaginas. This failure of fusion is the underlying anatomical cause for the entire duplicated system.
The exact reason why this fusion fails is not fully understood, but it is considered a congenital malformation. Because the urinary system develops in close proximity, individuals with this condition sometimes have other associated anomalies, such as only one kidney.
Effects on Menstruation and Pregnancy
The duplicated anatomy can have significant implications for a woman’s reproductive health, though many women with this condition remain asymptomatic. Menstruation is usually normal, but complications can arise if the vaginal septum or one of the vaginal canals is obstructed. An obstructed channel can lead to menstrual blood accumulating and causing severe pelvic pain or blockages, a condition sometimes referred to as obstructed hemivagina.
While conception is possible, pregnancies in a double uterus are generally considered higher risk. The smaller size of each individual uterine horn can result in less space for the fetus to grow and develop. This limited space contributes to an increased incidence of complications like premature birth, miscarriage, and the baby presenting in a breech position.
Women with Uterus Didelphys have a reduced chance of carrying a pregnancy to term compared to the general population. However, having two separate uteri means one can become pregnant while the other is not, or both can carry a pregnancy simultaneously.
Sexual activity is typically unaffected, though the vaginal septum can sometimes cause discomfort or bleeding during intercourse.
Discovering and Treating the Condition
The condition is often discovered incidentally during a routine pelvic examination, as a doctor may notice the presence of two cervices or the vaginal septum. For many individuals, the anomaly is not diagnosed until they seek medical care for symptoms like severe menstrual pain, difficulty using tampons, or a history of recurrent miscarriages. Imaging tools are then used to confirm the diagnosis and map the precise anatomy of the duplication.
Diagnostic tests commonly include transvaginal or abdominal ultrasound, which uses sound waves to create images of the internal organs. Magnetic Resonance Imaging (MRI) provides a detailed view of the uterine shape and the septum. Hysterosalpingography (HSG), which involves injecting dye into the uterus, can also visualize the two separate uterine cavities.
Treatment is usually only recommended if the duplication causes significant symptoms or reproductive difficulties. If a woman experiences pain or has an obstructed hemivagina, surgical correction to remove the vaginal septum is often performed. This procedure can alleviate symptoms and may improve the chances of a successful vaginal delivery in the future, although many pregnancies in a double uterus are delivered by Cesarean section due to the increased risk of fetal malposition.