Structural anomalies of the female reproductive tract may be divided into disorders of lateral fusion and disorders of vertical fusion of the Müllerian duct system. In the past, these disorders were diagnosed at or after menarche or later in life during evaluation of various forms of reproductive tract failure, such as infertility and pregnancy wastage. Newer techniques including pelvic ultrasound and magnetic resonance imaging have allowed diagnosis in the pediatric patient and on occasion, even in utero. Surgical correction of lateral-fusion defects (didelphic, bicornuate, septate, and unicornuate uteri) have remained essentially unchanged except for surgical reconstruction of the septate uterus. Surgical correction of vertical defects (vaginal septi and cervical agenesis or dysgenesis) has received considerable recent interest with the development of newer techniques that may be more effective than the reconstructive procedures of the past.