What is Uterus Didelphys?

Uterus Didelphys, or double uterus, is an extremely rare congenital abnormality of the Mullerian ducts that results in the development of two separate, smaller than normal uteri. Generally, a Uterus Didelphys is accompanied by two cervices and two vaginas. Only two fallopian tubes and ovaries are present, as in normal female reproductive systems.

One in every 3000 women will present with Uterus Didelphys. However, medical professionals question that number, as the condition generally goes undiagnosed unless there is a medical problem caused by the condition.

What Causes Uterus Didelphys?

In all embryos, Mullerian ducts are present before the formation of gender-specific sex organs. In female embryos, these ducts eventually fuse during the ninth week of pregnancy, creating a longitudinally-mirrored, normally-shaped single uterus, as well as a single cervix and vagina.

In women who are affected by Uterus Didelphys, their Mullerian ducts fail to fuse, creating a complete duplication of the uterus, cervix, and vagina. In women who don’t have complete failure of the fusion of the Mullerian ducts, two uteri are always present, although only one cervix or vagina may be present.

In women with two cervixes and vaginas, a membrane known as the vaginal septum normally separates the vaginas. A band of ligament connective tissue may also connect the two uteri.

There are no definitive causes for Uterus Didelphys, although some medial abnormalities occur in tandem with Uterus Didelphys, such as renal, and skeletal abnormalities, although this is far from common. Because of its association with renal (kidney) malformations, some medical professionals speculate the two conditions are related, although this has yet to be proven or even researched.

Symptoms of Uterus Didelphys:

There are few symptoms that result from Uterus Didelphys, beyond the actual physical abnormality. Many women have Uterus Didelphys without ever knowing that they have this condition, especially if the external genitalia appears to be normal.

However, for those who have Uterus Didelphys, the following symptoms may occur:

  • Have bleeding from both vaginas (if two are present)
  • Unusual pain during or before menstruation
  • Bleeding through a tampon or other unusual menstruation patterns

It's important to note that women who have Uterus Didelphys may become pregnant in either uterus, or both at once.

There are some less common, though still notable, conditions that can occur with Uterine Didelphys.

  • Miscarriages and infertility are uncommon, but can occur, although most women with this condition have normal, healthy pregnancies, with normal happy and healthy babies. 
  • It should be noted that during a pregnancy for a woman with a double uterus, overcrowding (due to the uterus being half-sized) and premature birth can occur. 
  • Some women with Uterus Didelphys need to undergo cesarean section births, but it is not a guarantee, and your specific situation should always be discussed with your obstetric practitioner.

What Is A Blind Hemivagina?

Some - but not all - women born with Uterus Didelphys also are afflicted with a condition called Blind Hemivagina.

A Blind Hemivagina is a condition in which one of the vaginal openings of one of the uteri is obstructed by the transverse position of the vaginal septum, causing the menstrual blood in the affected uterus to become trapped.

This condition does not allow menstrual blood to drain properly from the affected uterus, and can require surgical correction in order to allow proper drainage of the menstrual blood. Between 15% and 30% of women with Uterus Didelphys have this accompanying condition.

Diagnosis of Uterus Didelphys:

Many cases of Uterus Dideplhys are diagnosed during routine gynecological exams, when the medical practitioner notices there is a double cervix, or vaginal septum. However, this is not the only way to diagnose the condition and some women who have Uterus Didelphys are not diagnosed until a problem occurs, generally when pregnant, in labor, or postpartum.

If your doctor suspects there may be a uterine abnormality, he will order some tests to confirm his theory. These tests include:

  • MRI
  • Ultrasound
  • Hysterosalpingography - this is a test in which a special dye is injected into the uterus via the cervix to help the doctor examine the shape of the uterus. It's commonly referred to as a "dye-test", which is much easier to pronounce!
  • Hysteroscopy - the doctor inserts a small tube with a light on the end into the uterus through to examine the shape.
  • Laparoscopic Exploratory Surgery - small incisions are made in the navel and abdomen and small microscopes are inserted into the abdomen to examine the shape of the uterus. This is a major surgery and requires general anesthesia.

Treatment of Uterus Didelphys:

Surgical treatment of the separate uteri is not generally recommended, unless the malformation is extremely slight, and there is a fetus threatened by the shape of the uterus. Many doctors are loathe to perform any corrective surgery unless it is performed to save a developing fetus's life.

However, the vaginal septum can be removed by surgery, either for cosmetic reasons, or in women with a Blind Hemivagina.

Other Conditions Related to Uterus Didelphys:

It has been noted by medical practitioners that Uterus Didelphys and other Mullerrian defects have been associated with renal defects. However, the association is unclear.

During pregnancy, some women with this condition have been diagnosed with an incompetent cervix, which leads to miscarriage. Make sure to have your cervix examined during the latter part of your pregnancy to guard against miscarriage due to this condition.

Tips for Living With Uterus Didelphys:

Don't be worried about what your sexual partners may think! Some men think two vaginas is a good thing! (Go figure...)

If you choose to use tampons, insert one into each vagina, so that you won’t ruin those fabulous new pants you bought.

Always make sure to have a good relationship with your doctor and gynecologist, and report any unusual symptoms to them.

As sucky as it may seem, your condition does put you in the high-risk pregnancy category, so make sure you keep each and every pre-natal appointment! You want Mama and baby to be as healthy and happy as possible!

Related Resource Pages on Band Back Together:

Infertility

Invisible Illness

Pregnancy

Prematurity

Miscarriage

Trying to Conceive

High Risk Pregnancy

Additional Resources for Uterus Didelphys:

Wisegeek includes information on Uterus Didelphys and other uterine related conditions.

University of Pennsylvania Health System offers information on corrective surgery for Uterus Didelphys.