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Basics ⬇

Outline

BASICS

Overview!!navigator!!

  • Vaginitis is inflammation of the vagina, which can be infectious.
  • Vaginal/vulvar discharge can occur as a result of vestibulovaginitis, breeding injury, cervicitis, metritis, or abnormalities of the vagina or the urinary system (ectopic ureters).
  • Pneumovagina—one of the major causes of vestibular and vaginal inflammation; caused by abnormal VC.
  • Also may occur in fillies or mares in training or racing because of incomplete vulvar development.
  • Breed differences—increased incidence in mares with poor body condition (i.e. little fat) or less muscle in the perineal area (e.g. contrast Thoroughbreds and Standardbreds with Quarter Horses).
  • Severe postpartum vaginitis (often necrotic) is observed following dystocia and lengthy obstetrical manipulations or fetotomy

Genetics

Possible inheritance of poor VC, which results in vaginitis.

Signalment!!navigator!!

  • All females of breeding age.
  • Occurs more often in old mares

Signs!!navigator!!

Normal Discharge

  • Urine, especially the characteristic appearance of calcium carbonate crystals that may accumulate at/on the ventral vulvar commissure during estrus.
  • This occurs secondary to frequent urination and evacuation of sediment common in equine urine, especially during estrus

Abnormal Discharge

  • Consistency—mucoid or fluid, may be odiferous.
  • Color ranges—white to yellow to brown.
  • Note that mares may have vaginitis without external discharge.
  • Bloody vaginal discharge may be observed following breeding trauma

Historical Findings

  • Infertility or subfertility.
  • Periodic discharge throughout the cycle.
  • Dystocia

Physical Examination Findings

When secondary to infection or inflammation, there may be:

  • Discharge on the tail and perineum.
  • Fluid in the vagina or uterus

Causes and Risk Factors!!navigator!!

  • Poor VC.
  • Trauma at parturition.
  • Vaginal breeding injury.
  • Pneumovagina.
  • Multiparous broodmares are highest risk.
  • Less frequent in young maidens (not broodmares).
  • Congenital abnormalities of the vagina (double vagina) and urinary system (ectopic ureters)

Diagnosis ⬆ ⬇

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DIAGNOSIS

Differential Diagnosis!!navigator!!

  • Uterine disease/infection.
  • Urinary tract infection

CBC/Biochemistry/Urinalysis!!navigator!!

N/A

Other Laboratory Tests!!navigator!!

N/A

Imaging!!navigator!!

N/A

Other Diagnostic Procedures!!navigator!!

Careful speculum examination per vagina is the best means to establish a definitive diagnosis.

Pathologic Findings!!navigator!!

  • Hyperemia of the vaginal mucosa.
  • Fluid accumulation may be observed.
  • Abrasions, ulcerations, and lacerations may be present:
    • Recent or chronic—adhesions or fibrin deposition.
  • Vulvar discharge does not always accompany vaginitis.
  • Large amounts of discharge may be adhered to the tail or attract flies during summer months.
  • Discharge may be evident only when the mare is more excitable, being ridden, or otherwise worked

Treatment ⬆ ⬇

TREATMENT

  • Exact cause must be determined before treatment is initiated.
  • If only vaginitis (i.e. not secondary to injury), treatment needs only to halt additional contamination, and inflammation should subside.
  • Systemic antibiotics—no value.
  • Local therapy if antibiotics are indicated and used.
  • Postpartum application of antibiotic-containing emollient cream.
  • Caslick's vulvoplasty—repair deficits in VC, if present

Medications ⬆ ⬇

MEDICATIONS

Drug(s) of Choice

  • If indicated after vulvoplasty, nonirritating, local application of antibiotics may reduce the mare's discomfort.
  • This is usually unnecessary, as inflammation decreases rapidly once the source of irritation is resolved

Follow-up ⬆ ⬇

Outline

FOLLOW-UP

Patient Monitoring!!navigator!!

Reexamination 1–2 weeks after vulvoplasty.

Prevention/Avoidance!!navigator!!

Caslick's vulvoplasty or other cosmetic repair of vulvae and vestibular sphincter:

  • Mares born with poor VC have an increased likelihood of vaginitis; breed or individual mare predisposition.
  • Postpartum, if injured at foaling

Possible Complications!!navigator!!

If left untreated, may result in infertility, endometrial damage, and/or vaginal adhesions.

Expected Course and Prognosis!!navigator!!

  • If treated early in the course of disease, excellent resolution and normal fertility.
  • Postpartum necrotic vaginitis may result in vaginal adhesions

Miscellaneous ⬆ ⬇

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MISCELLANEOUS

Associated Conditions!!navigator!!

Linked with chronic vaginitis and uterine contamination:

  • Metritis.
  • Endometritis.
  • Pyometra

Age-Related Factors!!navigator!!

  • Prevalence increases with age.
  • Conformation problems and/or damage to the caudal genital tract increase with age and parity

Zoonotic Potential!!navigator!!

N/A

Pregnancy/Fertility/Breeding!!navigator!!

May prevent pregnancy or cause abortion.

Abbreviations!!navigator!!

VC = vulvar conformation

Suggested Reading ⬆ ⬇

Threlfall WR, Carleton CL. Vaginitis and vaginal discharge. In: Carleton CL, ed. Blackwell's Five-Minute Veterinary Consult Clinical Companion, Equine Theriogenology. Ames, IA: Wiley Blackwell, 2011:576–584.

Author(s) ⬆

Author: Ahmed Tibary

Consulting Editor: Carla L. Carleton

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