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Basics ⬇

Basics

Definition

Inflammation of the vagina

Pathophysiology

  • Juvenile vaginitis: unknown, possibly due to imbalances of juvenile vaginal mucosal glandular epithelium.
  • Primary adult-onset vaginitis: Brucella canis or canine herpesvirus.
  • Secondary adult-onset vaginitis: sequela to congenital anomaly, vaginal atrophy post-OHE, drug therapy, foreign body, neoplasia, urinary tract infection, urinary incontinence, systemic disease such as diabetes mellitus.

Systems Affected

Reproductive

Incidence/Prevalence

  • 0.7% incidence in one study
  • Primary vaginitis-very rare

Signalment

Species

Primarily dog

Mean Age and Range

  • Juvenile vaginitis: less than 1 year of age, ranging from 8 weeks to 1 year, prepubertal animals.
  • Adult-onset vaginitis: over 1 year of age, ranging from 1 to 16 years of age.

Signs

Historical Findings

Juvenile Vaginitis

  • May have no significant history
  • Vulvar discharge-seen most often following urination
  • Vaginal irritation
  • Crusting of the hair coat in the vulvar region
  • Scooting
  • Excessive vulvar licking
  • Perivulvar pruritus
  • Inability to housetrain

Adult-Onset Vaginitis

  • Vulvar discharge
  • Excessive vulvar licking
  • Pollakiuria
  • Pain during urination
  • PU/PD
  • Pruritus
  • Urinary incontinence
  • Infertility

Physical Examination Findings

  • Vulvar discharge: mucoid to purulent, scant to copious.
  • Vulvar hyperemia.
  • Vestibular hyperemia.
  • Perivulvar dermatitis.
  • Digital examination-strictures and hymens identified at vaginovestibular junction, granular irregularity of mucosa, especially wall opposite urethral papilla.
  • Vaginoscopy-diffuse hyperemia of vaginal and vestibular mucosa, prominent lymphoid follicles, luminal exudates, erythema of the urethral papilla or clitoral fossa; presence of foreign body, neoplasia, or congenital abnormalities.

Causes

  • Prepubertal vagina.
  • Infantile vulva.
  • Urinary tract infection.
  • Urinary or fecal incontinence.
  • Foreign body.
  • Neoplasia-TVT, leiomyoma
  • Bacterial: Brucella canis, E. coli, Streptococcus spp., Staphylococcus intermedius, Pasteurella spp., Chlamydia, Pseudomonas spp., Mycoplasma spp.
  • Viral-canine herpesvirus.
  • Congenital anomalies including vaginovestibular strictures, inverted vulva.
  • Vaginal trauma.
  • Vaginal hematoma.
  • Vaginal abscess.
  • Systemic disease-diabetes mellitus.
  • Zinc toxicity.
  • Exogenous or endogenous androgens.

Risk Factors

  • Alteration of normal vaginal flora by exogenous antibiotic administration.
  • Clitoral hypertrophy secondary to exogenous or endogenous (hermaphrodites) androgens.
  • Inverted or recessed vulva.
  • Obesity.
  • Abnormal conformation.
  • Vaginal trauma.

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

  • Normal-hemorrhagic or serosanguinous discharge during proestrus and may continue into estrus.
  • Normal-slight purulent exudates may be normal in early diestrus; neutrophils and non-cornified epithelial cells seen on cytologic examination.
  • Normal mucus discharge during pregnancy.
  • Normal-postpartum discharge for up to 6–8 weeks; odorless dark brown or hemorrhagic discharge; substantial amounts are normal for up to 4 weeks.
  • Subinvolution of the placental sites-hemorrhagic discharge lasting longer than 8 weeks postpartum.
  • Cystourethritis.
  • Foreign body.
  • Pyometra.
  • Metritis.
  • Retained placenta(s).
  • Clitoral hypertrophy.
  • Embryonic or fetal death.
  • Urine or feces contamination secondary to congenital anomaly or acquired condition.
  • Perivulvar dermatitis.
  • Urine contaminationwith ectopic ureter.
  • Incontinence secondary to “hypoestrogenism.”
  • Sexual differentiation disorder.
  • Vaginal neoplasia.
  • Vaginal trauma.
  • Vaginal hematoma.
  • Vaginal abscess.
  • Ovarian neoplasia.
  • Zinc toxicity.

CBC/Biochemistry/Urinalysis

  • Usually within normal limits.
  • Adult onset: may indicate urinary tract infection, hematuria, or systemic disease such as diabetes mellitus to pinpoint underlying cause.
  • Urinalysis may indicate dilute urine in young puppies (normal finding).

Other Laboratory Tests

  • Brucella canis serology: rapid slide agglutination test (D-Tec CB; Zoetis, (888) 963-8471); agar gel immunodiffusion test (Cornell University Diagnostic Laboratory, (607) 253-3900); bacterial culture of whole blood or lymph node aspirate.
  • Serum progesterone concentration-to determine if patient is in estrus or in the luteal phase ( 2 ng/mL).

Imaging

Ultrasonography

  • Rule-out uterus as source of any vaginal discharge.
  • Detection of masses: neoplasia, granuloma, or foreign body; saline distention of the vagina may help visualization.

Contrast Radiography-Vaginogram /Urethragram/Cystogram/IVP

  • Identify abnormal conformation or structure (e.g., neoplasia or foreign body) within the vagina.
  • Rule-out vestibulovaginal strictures, rectovaginal and urethrovaginal fistulas.
  • Rule-out differentials and help localize the problem.

Diagnostic Procedures

Vaginal Culture and Sensitivity

  • Performed prior to other diagnostic procedures.
  • Use guarded swab to sample cranial vagina.
  • 74% of adult-onset cases positive for bacterial growth, of which 64% were pure cultures.
  • Most common organisms are E. coli, Streptococcus spp., and Staphylococcus intermedius.
  • Other organisms include Mycoplasma, Pasteurella, Pseudomonas spp., Chlamydia.
  • Reminder: the vagina is not a sterile environment and culture of normal bitches results in growth of normal vaginal flora; use of vaginal cytology and other diagnostic tools is essential for interpretation of culture results.

Vaginal Cytology

  • Always performed in conjunction with vaginal culture.
  • Juvenile vaginitis: usually polymorphonuclear leukocytes ± bacteria.
  • Adult-onset vaginitis: usually indicative of septic inflammation.
  • Evaluate epithelial cells for cornification-cornification present under the influence of estrogen.
  • Determine nature of discharge-inflammatory, blood, presence of fecal material.

Vaginoscopy

  • Rigid cystourethroscope, ureteroscope, pediatric gastroscope, proctoscope, or flexible endoscope used to visualize vagina.
  • Visualization of anomalies: persistent hymen, neoplasia, foreign body, trauma, abscess, and evaluation of the vaginal mucosa.
  • Identify source of vaginal discharge-uterine, vaginal, vestibular, or urethral.
  • Removal of foreign body or biopsy of vaginal mass.
  • The vaginal wall can be thin in ovariectomized bitches-exercise care when using rigid cystourethroscope and ureteroscope.

Other

  • Digital vaginal examination-may be best diagnostic tool for identifying strictures in posterior tract.
  • Biopsy and histopathology of vaginal mass.
  • Urine culture and sensitivity-identify ascending/concurrent infections.

Treatment ⬆ ⬇

Treatment

Appropriate Health Care

  • Correction/removal of underlying cause.
  • Most often treated as outpatient.
  • Surgical management may be necessary to remove foreign bodies or masses or for correction of structural anomalies.
  • Prevention of self mutilation-use of Elizabethan collars.

Activity

Not altered

Diet

Not altered

Client Education

General

  • Brucella canis–positive patients should be isolated. Euthanasia recommended due to zoonotic potential and lack of effective treatment.
  • Exogenous estrogens and androgens must be removed from the environment.

Juvenile Vaginitis

  • Generally resolves without treatment. Advise patience.
  • Should resolve after first estrous cycle, if not before. Patient may need to go through one estrous cycle prior to elective OHE.

Adult-Onset Vaginitis

  • Usually occurs secondary to underlying cause.
  • Generally resolves after correction of inciting cause.
  • If no primary cause can be identified, high likelihood of spontaneous recovery without treatment.

Surgical Considerations

  • Correction of structural anomaly
  • Removal of foreign body
  • Removal of vaginal mass
  • Episioplasty
  • Vaginectomy may be performed in refractory cases.

Medications ⬆ ⬇

Medications

Drug(s) Of Choice

Juvenile Vaginitis

  • No treatment for bitches in uncomplicated cases.
  • Antibiotic therapy warranted in patients with excessive discomfort (pain or excessive vulvar licking) and/or urinary tract infections.
  • Antibiotic selection based on culture and sensitivity.

Adult-Onset Vaginitis

  • Systemic antibiotic selection based on positive cranial vaginal culture and sensitivity; treat for 4 weeks.
  • NSAIDs may be used to help decrease inflammation.
  • Anti-inflammatory dose of corticosteroids may be helpful in decreasing inflammation and discomfort, but side effects are less desirable and may result in subsequent infection.
  • DES-for idiopathic or recurrent vaginitis in spayed bitches; helps to reestablish normal mucosal integrity, increases vaginal epithelial cornification, normalization of vaginal vault, use lowest effective dose; 0.5 mg PO for dogs less <9 kg or 1 mg PO for dogs >9 kg q24h for 7 days, then taper dose over 2–4 weeks and maintain at lowest effective dose for potential lifelong therapy.

Contraindications

  • Antibiotic therapy in patients may result in alteration of normal flora and development of infection secondary to treatment.
  • Vaginal douches with antibiotic/antiseptic agents may be irritating to the vaginal mucosa and worsen the condition.
  • Corticosteroid administration may worsen concurrent urinary tract infection.

Precautions

Estrogen administration may increase risk of pyometra in intact animals.

Possible Interactions

Effects of hydrocortisone may be potentiated with concurrent estrogen therapy.

Alternative Drug(s)

  • Juvenile vaginitis may be treated with DES to induce estrus in refractory cases, but long-term effects are not documented.
  • Moist towelettes/baby wipes may be used to clean the perivulvar area.

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

Juvenile Vaginitis

  • Reevaluate if symptoms become more severe or intolerable.
  • Reevaluate after first estrous cycle.

Adult-Onset Vaginitis

  • Recheck if symptoms do not resolve after removal of underlying cause.
  • Reculture 5–7 days after cessation of antibiotic therapy or if symptoms continue despite therapy.

Prevention/Avoidance

  • Delay elective OHE until after first estrous cycle in juvenile vaginitis cases
  • Avoid using antibiotics in unwarranted cases
  • Maintain good body weight and condition
  • Avoid vaginal douching
  • Avoid exogenous androgen therapy.

Expected Course and Prognosis

  • Juvenile vaginitis-onset at 6 weeks to 6–12 months of age; duration of days to months but typically intermittent; usually resolves with time or after first estrous cycle.
  • Adult-onset-normally resolves after removal/treatment of inciting cause; antibiotic therapy may hasten resolution in warranted cases, NSAIDs may help resolve inflammation.

Miscellaneous ⬆

Miscellaneous

Associated Conditions

Perivulvar dermatitis

Age-Related Factors

Juvenile vaginitis may be present in prepubertal dogs, usually <1 year of age.

Zoonotic Potential

Brucella canis-uncommon cause of vaginitis but should be ruled out.

Pregnancy/Fertility/Breeding

  • Vaginitis during pregnancy is rare but may result in ascending infection and subsequent abortion. Resolution of vaginitis should result in a good prognosis for fertility if underlying cause does not affect fertility prognosis.
  • Structural anomalies such as persistent hymen may prevent natural matings to occur, or could predispose to a dystocia if artificially inseminated.
  • Scarring secondary to trauma may result in excessive fibrous tissue and decreased distensibility of the vagina.

Abbreviations

  • DES = diethylstilbestrol
  • OHE = ovariohysterectomy
  • NSAID = nonsteroidal anti-inflammatory drug
  • PU/PD = polyuria/polydypsia
  • TVT = transmissible venereal tumor
  • UTI = urinary tract infection

Suggested Reading

Bjurström L, Linde-Forsberg C. Long-term study of aerobic bacteria of the genital tract in breeding bitches. Am J Vet Res 1992, 53:665–669.

Johnson CA. Diagnosis and treatment of chronic vaginitis in the bitch. Vet Clin North Am 1991, 21:523–531.

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

Parker NA. Clinical approach to canine vaginitis: A review. Theriogenology 1998, 112–115.

Author Julie T. Cecere

Consulting Editor Sara K. Lyle

Acknowledgment The author and editors acknowledge the prior contributions of Leeah R. Chew and Beverly J. Purswell.

Client Education Handout Available Online