Developmental Differences of the Female Reproductive Organs

The uterus and part of the vagina are formed from 2 ridges of tissue on the left and right side of the body. This happens before you are born. These 2 ridges must come together in the middle to form 1 structure. When the 2 parts do not come together all the way you may develop differences (also called congenital anomalies) in your reproductive organs (this includes the uterus, cervix, vagina and hymen).

Some people have a type of developmental difference of the reproductive organs, including:

• No uterus and very little vagina – this is found during puberty, when a teen does not have a period.
• Extra tissue dividing the uterus or vagina (a septum) – this is usually found during an exam or an ultrasound.
• Extra tissue at the hymen, or entrance to the vagina – this is usually found when it is hard to place a tampon, have sex or during a routine pelvic exam
• Unicornuate – the uterus develops only on 1 side
• Didelphys – instead of 1 uterus, your body forms 2 uteri
• Bicornuate or arcuate – the uterus has 2 sides

Some of these anomalies are also connected with differences in the formation of the kidneys.

Most teens with developmental differences of their uterus do not have symptoms. You may only find out that you have a uterine or vaginal difference during a routine pelvic exam or with an ultrasound.

Some people will have signs or symptoms depending on the type of developmental difference. This may include:

• No menstrual (period) bleeding outside of the body. This may mean the vagina did not develop all the way or a blockage is stopping menstrual blood from leaving the uterus. You will likely have pain if you have a blockage.
• Higher risk for miscarriage, infertility (unable to get pregnant), preterm (early) labor, or a breech baby (bottom first) during labor if you have a uterine septum, bicornuate uterus, didelphys uterus or unicornuate uterus.

To find out if you have a developmental difference of the reproductive organs, your doctor will start with a physical exam. Your doctor may also:

• Schedule you for an MRI (magnetic resonance imaging) or ultrasound so they can look at your reproductive organs. This allows your doctor to find out if you have a uterine septum, bicornuate uterus, unicornuate uterus or do not have a uterus. These tests may also be used to look at your kidneys to see if they have developed normally.
• Recommend a special X-ray (hysterosalpingogram) to look at the inside of the uterus or a procedure where we make small cuts (incisions) to insert a tiny camera and light in your belly (laparoscopy) to look at the outside of the uterus.

Many teens with a developmental difference of the uterus will not need any treatment. If you are having severe pain with your periods or repeat miscarriages, your provider might recommend surgery. If you have:

• A uterine or a vaginal septum, we may remove this by surgery.
• A part of the uterus that is not fully developed, this may be removed by surgery.
• A vagina that is not fully developed, you can use vaginal dilators to stretch it to a normal length. Some teens want a vagina to be made surgically. We may do this by taking tissue from another part of your body and making it into the shape of a vagina.
• Extra tissue at the hymen or entrance to the vagina, we can remove it in clinic or in the operating room.
• A history of preterm (early) delivery, a provider may use stitches to help keep the cervix closed (cerclage) during pregnancy.