What is a recessed vulva?
A recessed vulva, also known as a juvenile or hypoplastic vulva, is a conformational (structural formation) issue that occurs in female dogs. In this condition, the vulva is recessed within, or partially hidden by, surrounding folds of skin. A recessed vulva is thought to have a genetic basis, though this has not been definitively determined. The condition is more common in medium to large-breed dogs, especially those who are overweight.
What is the significance of a recessed vulva?
A recessed vulva can predispose a dog to vaginitis and/or urinary tract infections. The skin folds around the vulva can trap moisture when the dog urinates. This moisture, combined with the dog’s body heat, can make it very easy for bacteria to grow in this area. These bacteria can affect the skin folds around the vulva (perivulvar dermatitis), migrate into the vagina (leading to vaginitis), or migrate up the urinary tract (leading to a urinary tract or bladder infection).
"A recessed vulva can predispose a dog to vaginitis and/or urinary tract infections."
What are the clinical signs of a recessed vulva?
In many affected dogs, clinical signs are related to inflammation and infection within the skin folds that surround the vulva. Affected dogs might be seen scooting (dragging their vulva across the floor to relieve itching) or licking at their vulva excessively.
In some cases, owners notice a foul odor coming from the area of their dog’s vulva; this odor is associated with infection. Affected dogs may also become incontinent, leaking small or large amounts of urine when they sleep. In other cases, a recessed vulva leads to urinary tract infections. Signs of a urinary tract infection may include urinary accidents in a housetrained dog, straining to urinate, visible blood in the urine, or a foul odor to the urine. This may occur in addition to the signs of skin fold inflammation described above, or the signs of urinary tract infection may be the only clinical signs.
Some dogs show no clinical signs and the recessed vulva is found incidentally upon physical examination by a veterinarian.
"Affected dogs may also become incontinent, leaking small or large amounts of urine..."
How is a recessed vulva diagnosed?
A recessed vulva can be diagnosed by your veterinarian on a physical examination. In an affected dog, the vulva cannot be seen because it is covered by overlaying skin folds. Closer examination may reveal accumulated moisture and debris within the skin folds surrounding the vulva.
Your veterinarian will likely perform additional diagnostic tests to determine what effects, if any, the recessed vulva is having on your dog’s health. These tests may include blood work (a complete blood cell count and serum biochemistry profile), a urinalysis (to assess the composition of the urine), a urine culture (to identify bacteria present in the urine), and/or imaging of the bladder using radiographs (X-rays) or ultrasound, to assess for bladder stones and other abnormalities. They may also take swabs from the skin folds around the vulva to check what type of cells (such as inflammatory, bacterial, or yeast cells) may be contributing to the irritation your dog is experiencing.
How is a recessed vulva treated?
Many dogs with a recessed vulva develop bacterial infections that require treatment. The antibiotics used for treatment vary based upon the type and severity of infection. In the case of a mild skin infection, topical antibiotics may be effective. In the case of vaginitis, bladder infections, or more severe skin infections, oral antibiotics are often required.
Once the infection has been treated, it is important to consider options to address the underlying conformational defect. This is especially the case when a dog experiences recurrent infections or infections that do not resolve with appropriate antibiotic therapy. If the underlying conformational defect is not addressed, the infections will continue to recur.
"If the underlying conformational defect is not addressed, the infections will continue to recur."
There are two primary treatment options for a recessed vulva:
1. Medical management. In dogs that are only mildly affected, topical treatments with medicated shampoos or wipes may be sufficient to keep signs at bay and prevent secondary infections. Weight loss in overweight dogs can be beneficial by decreasing the size of the fat/skin folds surrounding the vulva.
2. Surgical treatment. In dogs that are severely affected, or who do not respond to medical treatment, a vulvoplasty or episioplasty may be considered. This procedure corrects the conformational defect and restores normal conformation of the vulva. See handout “Vulvoplasty (Episioplasty)” for further information on this procedure.
What is the prognosis for a recessed vulva?
The prognosis for this condition depends on its severity and which treatment option is attempted. In general, dogs who undergo a vulvoplasty experience a significant improvement in clinical signs. In dogs given medical treatment only, the prognosis depends on the severity of the condition and the response to treatment.