Uterus Didelphys, or a double uterus, is a rare condition that occurs in female fetuses as they develop in the womb. Normally, two tubes called Mullerian ducts are fused together to create a single uterus, but occasionally these two tubes fail to join. When this happens, two separate uteri form, usually with double cervices and double vaginas as well. They are both fully functioning uteri, and some women with this condition have given birth to twins who were each housed in a separate uterus. This means it is possible to deliver babies several days or weeks apart, though many with multiple births opt for scheduled cesarean sections.
The cause of this anomaly is not known and there are often no symptoms present, so many women never even know they have uterus didelphys. Other women may have abnormal pain during menses, and some will have reproductive and pregnancy issues. If uterus didelphys is suspected, a doctor will perform a pelvic exam. During this exam, if a double vagina and double cervix are present, doctors may order other tests to assess the condition of the uteri. Diagnostic procedures used to view the uterus include ultrasound, magnetic resonance imaging (MRI), and hysterosalpingography, which is a cumbersome label for a procedure that involves injecting a dye into the uterus and taking special x-rays.
If no symptoms are present and there are no complications with fertility and pregnancy, then uterus didelphys does not require any treatment. Sometimes women with this condition will have pregnancy complications due to the smaller size each uterus. Miscarriage, infertility, and delivery issues are all possibilities. Breech births are especially common for women with uterus didelphys, and many end up having cesarean sections. Doctors are loathe to perform surgery to correct this condition, as the symptoms do not typically warrant the risk of surgery. However, if it's only a thin layer separating the uteri, and a fetus is at risk, doctors may remove the barrier.
The most important thing for pregnant women with uterus didelphys to remember is that the condition puts one in the high-risk pregnancy category. This means all the normal safety precautions associated with any pregnancy should be tightly adhered to, and doctor's orders should be closely followed to avoid miscarriage, ectopic pregnancy, and premature birth. An incompetent cervix is one of the factors that contributes to premature labor, so it is essential that women have the cervix checked often in the latter portion of a pregnancy.
Symptoms of Uterus Didelphys
It’s possible to have uterus didelphys and not know it before visiting a gynecologist. Unusual or intense pain doesn’t always result from the condition.
Women with two vaginas might go to the doctor when they bleed excessively during menstruation. They’ve most likely used one tampon in one vagina without knowing that blood is coming from a second uterus or possible second vaginal opening.
Women with uterus didelphys might also experience severe pain and cramps before and during their period. It can also make sex painful. However, since they’ve had this condition since birth, many women find it normal and don’t think to question the root issue.
In fact, some women may think that they have ovarian cysts or endometriosis instead. There is some overlap in possible symptoms, such as painful periods, difficulty becoming pregnant or keeping a pregnancy, pain during sex, and heavy bleeding during a menstrual cycle.
Uterus Didelphys Diagnosis
Since there are frequently no symptoms of uterus didelphys, you might find out you have it after you have a pelvic exam or visit the doctor due to difficulties carrying out a pregnancy.
Your gynecologist will notice two uteruses during a pelvic exam. They’ll likely recommend an ultrasound or MRI for further testing. For uterus didelphys, there are two additional types of tests: a Sonohysterogram and Hysterosalpingography.
A Sonohysterogram is similar to an ultrasound but requires the doctor to inject fluid into the uterus through the vagina and cervix. Hysterosalpingography involves injecting dye into the uterus to help it appear on X-rays.
These tests will help your doctor see the size and shape of your uterus. They’ll understand how much your Mullerian ducts grew together, if at all. After seeing your uterus in these test results, they can advise you on issues with having a successful pregnancy.
Medical professionals can also suggest treatment to alleviate any pain you might experience due to uterus didelphys.
Uterus Didelphys Complications
Some think this failure of Mullerian duct merging is a genetic condition. With that in mind, it’s possible for babies with only one kidney or small kidneys also to have uterus didelphys or other sex organ irregularities.
As a result of Mullerian duct problems, some women develop Herlyn-Werner-Wunderlich syndrome. It can cause pelvic and abdominal pain. In women who also have a double vagina, this syndrome can block one side and cause further complications, including ipsilateral renal agenesis and obstructed hemivagina. Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome can result in renal and mullerian anomalies.
Women with uterus didelphys are more likely to have a congenital vesicovaginal fistula (CVVF). A CVVF is an opening between your bladder and vagina. Urine leaks from the bladder and into your vagina, causing incontinence. It can also lead to side effects like fever, nausea, diarrhea, abdominal pain and weight loss. It won’t heal on its own, so you’ll need medical intervention.
Another bladder complication relating to uterus didelphys is bladder exstrophy. The condition can vary in severity. In some instances, the bladder forms outside of the fetus and can’t function normally.
In other occurrences, the bladder isn’t round, as it should be, so it can cause incontinence. It can also cause two bladders to form. Doctors can often spot this condition on an ultrasound, but it requires surgery to correct.
If you have uterus didelphys, you’re more likely to experience other pregnancy complications. Women with uterus didelphys might have a spontaneous abortion, premature labor, breech birth, or decreased live births.
Uterus Didelphys Treatment
Surgery is rarely a recommended treatment for uterus didelphys. If the patient has trouble carrying out a pregnancy, some surgeons might suggest uniting the uterus if there’s only a partial division between the Mullerian ducts.
There must be no other potential cause of the pregnancy losses, either, because those might be easier to treat than going through surgery.
Since there’s a good chance you won’t experience any painful side effects of uterus didelphys, you might be able to avoid seeking treatment. Many women with this condition still have healthy sex lives and pregnancies.
However, if you have a double vagina as well as a double uterus, your doctor may suggest removing the division between the two. This can make giving birth vaginally much easier and may help you avoid an unnecessary C-section.