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Basics ⬇

Outline

BASICS

Overview!!navigator!!

  • Displacement of all or part of the vaginal wall posteriorly through the vulva
  • The condition is primarily seen in the postpartum period in mares and is thought to be due to relaxation of the vaginal wall and vulvar lips, allowing eversion of the vagina
  • Increased abdominal pressure (i.e. straining) places additional pressure on the vaginal wall
  • Rarely, straining may be associated with the presence of pelvic or cervical masses

Signalment!!navigator!!

  • All breeds
  • All females of breeding age

Signs!!navigator!!

  • The vaginal wall protrudes through the vulva
  • The vaginal wall may become damaged and permit paravaginal fat to protrude through the prolapsed wall
    • This protruded fat may cause additional straining and further prolapse
  • The protruding tissue has a characteristic pink to red color, depending on the length of time it has been outside the body
  • Essential to differentiate vagina from bladder, intestines, uterus, cervix, and vestibule before initiating treatment

Causes and Risk Factors!!navigator!!

  • Generally secondary to dystocia or other abnormalities that initially predispose mares to everting part of the vaginal wall
  • This may cause straining and additional tissue protrusion and injury

Diagnosis ⬆ ⬇

Outline

DIAGNOSIS

Differential Diagnosis!!navigator!!

  • Persistent hymen and hematocolpometra
  • Eversion of the bladder, uterus, or cervix
  • Vaginal tears through which paravaginal fat or intestines may be protruding
  • Eversion of the vestibular wall

CBC/Biochemistry/Urinalysis!!navigator!!

N/A

Other Laboratory Tests!!navigator!!

N/A

Imaging!!navigator!!

Ultrasonography may be indicated to examine the prolapsed tissue, which may contain other structures.

Other Diagnostic Procedures!!navigator!!

Careful visual and digital examination to differentiate the vaginal wall from other prolapsed tissues.

Pathologic Findings!!navigator!!

Protrusion of the vaginal wall through the vestibule and vulvar lips.

Treatment ⬆ ⬇

TREATMENT

  • Reduction of prolapse, i.e. return tissues to their normal anatomic location, and terminate subsequent expulsive efforts; critical to permanent resolution
  • Reduction of inflammation, if present, is advisable
  • No restriction of activity, unless the activity increases abdominal pressure
  • Any protrusion of tissue through the vulvar lips requires immediate attention
  • Caslick's vulvoplasty may help prevent further vaginal irritation and, thus, decrease the likelihood of additional straining and tissue damage. Vulvoplasty, however, does not prevent recurrent prolapse from straining

Medications ⬆ ⬇

Outline

MEDICATIONS

Drug(s) of Choice!!navigator!!

  • Epidural anesthetic may be indicated to reduce straining
  • Application of local, nonirritating antibiotics may aid in recovery

Contraindications/Possible Interactions!!navigator!!

N/A

Follow-up ⬆ ⬇

Outline

FOLLOW-UP

Patient Monitoring!!navigator!!

At reexamination, careful and gentle assessment of previously affected tissues to prevent renewed irritation and reinitiation of straining.

Prevention/Avoidance!!navigator!!

  • Treat any conditions, e.g. vaginal damage or irritation, that may initiate straining and result in eventual prolapse of the vaginal wall
  • Once recognized, initiate treatment of prolapsed vaginal tissue as quickly as possible; limit tissue trauma

Possible Complications!!navigator!!

Vaginitis, vaginal adhesions, vaginal tears.

Expected Course and Prognosis!!navigator!!

  • Rapid recovery if the inciting cause is removed
  • Satisfactory recovery if further damage can be avoided

Miscellaneous ⬆ ⬇

Outline

MISCELLANEOUS

Associated Conditions!!navigator!!

N/A

Age-Related Factors!!navigator!!

N/A

Zoonotic Potential!!navigator!!

N/A

Pregnancy/Fertility/Breeding!!navigator!!

Usually occurs after parturition.

Suggested Reading ⬆ ⬇

Cox JE. Surgery of the Reproductive Tract in Large Animals, 3e.Liverpool, UK: Liverpool University Press, 1987:127–143.

Author(s) ⬆

Author: Ahmed Tibary

Consulting Editor: Carla L. Carleton

Acknowledgment: The author and editor acknowledge the prior contribution of Walter R. Threlfall.