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Basics ⬇

Basics

Overview

  • Protrusion of spherical or donut-shaped mass from vulva during proestrus or estrus, rarely during gestation, parturition, or after administration of estrogenic drugs.
  • Type I-slight eversion of vaginal floor cranial to the urethral orifice but no protrusion through vulva.
  • Type II-vaginal tissue prolapses through vulvar opening (tongue-shaped mass).
  • Type III-donut-shaped eversion of the entire circumference of vaginal wall, including the urethral orifice, seen ventrally on the prolapsed tissue.
  • Exaggerated response of vaginal mucosa to estrogen, some affected animals have follicular cysts.
  • Despite the name, the change seen histopathologically is edema rather than hyperplasia or hypertrophy if occurring during proestrus or estrus.
  • Severe prolapse-may occlude urethra and prevent normal urination.
  • True vaginal prolapse without hyperplasia or edema occurs rarely postpartum and may include uterine body and horns.

Signalment

  • Young (most 18–22 months, range 6 months to 4.6 years), large-breed bitches.
  • Predisposed breeds-large and brachycephalic breeds (boxer, mastiff, English bulldog, Saint Bernard); Labrador and Chesapeake Bay retrievers; German shepherd; springer spaniel; walker hound; Airedale terrier; American pit bull terrier.
  • Hereditary component probable-increased incidence in some family lines.

Signs

Historical Findings

  • Onset of proestrus or estrus.
  • Although rare, can be seen during diestrus or at parturition (8–12% of cases occur at parturition); or after administration of estrogenic drugs.
  • Licking of vulvar area.
  • Failure to allow copulation.
  • Dysuria.
  • Previous occurrence.

Physical Examination Findings

  • Protrusion of round, tongue-shaped, or donut-shaped tissue mass from the vulva.
  • Vaginal examination-locate lumen and urethral orifice; types I and II: vaginal lumen is dorsal to the prolapse; type III: lumen is central to the prolapse; urethral orifice is ventral to the prolapse with all three types.
  • Tissue may be dry or necrotic.

Causes & Risk Factors

  • Estrogen stimulation
  • Genetic predisposition
  • Dystocia
  • Increased abdominal pressure

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

  • Vaginal polyp-differentiated by vaginal examination.
  • Vaginal neoplasia-transmissible venereal tumor and leiomyoma; differentiated by signalment, stage of cycle, and vaginal examination.
  • Clitoral hypertrophy; differentiated by physical examination.

CBC/Biochemistry/Urinalysis

N/A

Other Laboratory Tests

N/A

Imaging

N/A

Diagnostic Procedures

Biopsy (old bitch)-differentiate from neoplasia

Treatment ⬆ ⬇

Treatment

Surgical Considerations

  • Ovariohysterectomy-prevents recurrence; may hasten resolution.
  • Severe condition-requires surgical reduction or resection; identify and catheterize urethra, 25% recurrence at next cycle after surgery.
  • With dystocia, cesarean section required, ovariohysterectomy may be necessary.
  • Surgical amputation of the prolapsed tissue in an awake, standing bitch has been described.
  • When occurring during pregnancy, both resection of prolapse and surgical reduction with accompanying hysteropexy have been successfully reported. Vaginal delivery with concurrent vaginal prolapse has been reported; close monitoring for obstructive dystocia is recommended.

Medications ⬆ ⬇

Medications

Drug(s)

GnRH (2.2 µg/kg IM) or hCG (1,000 IU IM)-if breeding not planned that cycle; may hasten ovulation and resolution by a couple of days; not effective if given after ovulation (progesterone >8–10 ng/mL).

Contraindications/Possible Interactions

Avoid progestational drugs, they can induce pyometra.

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

Monitor health of prolapsed tissue and the ability to urinate.

Prevention/Avoidance

Ovariohysterectomy-recommended owing to genetic component and likelihood of recurrence.

Possible Complications

Type III-may affect urethra and prevent normal urination.

Expected Course and Prognosis

  • Medical treatment-prognosis for recovery good, except with urethral involvement.
  • Surgical intervention for type III-prognosis good.

Miscellaneous ⬆

Miscellaneous

Abbreviations

  • GnRH = gonadotropin-releasing hormone
  • hCG = human chorionic gonadotropin

Internet Resources

Schaeferes-Okkens AC. Vaginal Edema and Vaginal Fold Prolapse in the Bitch, Including Surgical Management, 2001.

http://www.ivis.org/advances/Concannon/schaeferes/IVIS.pdf.

Suggested Reading

Feldman EC, Nelson RW. Vaginal defects, vaginitis, and vaginal infections. In: Feldman EC, Nelson RW, eds., Canine and Feline Endocrinology and Reproduction. Philadelphia: Saunders, 2004, pp. 901–928.

Gouletsou PG, Galatos ASD, Apostolidis K, et al. Vaginal fold prolapse during the last third of pregnancy, followed by normal parturition in, in a bitch. Anim Reprod Sci 2009, 112(3–4):371–376.

Johnston SD, Root Kustritz MV, Olson PNS. Disorders of the canine vagina, vestibule, and vulva. In: Johnston SD, Root Kustritz MV, Olson PNS, eds., Canine and Feline Theriogenology. Philadelphia: Saunders, 2001, pp. 225–242.

Author Joni L. Freshman

Consulting Editor Sara K. Lyle