Vulvoplasty (Episioplasty)

By Catherine Barnette, DVM

Care & Wellness, Medical Conditions, Surgical Conditions, Pet Services

What is a vulvoplasty?

dog_recessed_vulva_2018-01Vulvoplasty, also known as episioplasty, is a surgical procedure that your veterinarian may recommend to correct a conformational (structural formation) issue known as a recessed vulva.

Dogs with a recessed vulva have skin folds that hang over the vulva. In a vulvoplasty, your veterinarian will remove a crescent-shaped piece of tissue from above the vulva. This lifts the skin around the vulva, pulling it into a more normal conformation.

Why would my veterinarian recommend a vulvoplasty?

In a dog with a recessed vulva, folds of skin and fat hang over the vulva. These skin folds often trap urine, leading to a warm, moist environment that allows bacteria to proliferate. Affected dogs may develop inflammation or infection of the skin folds, vaginitis (vaginal inflammation/infection), or urinary tract infections. Dogs may experience recurrent infections, requiring long-term treatment with topical or oral antibiotics. In some cases, recurrent or long-term use of antibiotics may lead to antibiotic-resistant infections.

"Affected dogs may develop inflammation or infection of the skin folds, vaginitis (vaginal inflammation/infection), or urinary tract infections."

Restoring the normal conformation of the vulva helps improve ventilation in this area, allowing the skin to dry out and making it more difficult for bacteria to grow. Additionally, this surgery prevents skin layers from rubbing together and further contributing to vulvar inflammation.

What preparation will my pet need prior to vulvoplasty?

Before surgery, it is important that any skin infection present around the vulva be resolved. In many cases, this requires a course of oral antibiotics. If your veterinarian suspects an antibiotic-resistant infection, bacterial cultures may be performed to guide the choice of an appropriate antibiotic. It is important to clear any existing infection prior to surgery, because infection at the surgery site could prevent the wound from healing normally.

"Before surgery, it is important that any skin infection present around the vulva be resolved. In many cases, this requires a course of oral antibiotics."

Your veterinarian may also recommend pre-anesthetic bloodwork prior to surgery. This bloodwork allows your veterinarian to assess your dog's white and red blood cell counts, platelet counts, and serum biochemistry profile prior to surgery. Normal pre-anesthetic bloodwork helps to assure your veterinarian that your pet is a good candidate for anesthesia. If your pet has abnormalities on bloodwork, these may need to be addressed prior to surgery.

Your veterinarian will also provide you with instructions regarding food and water intake prior to anesthesia. In most cases, you will need to withhold food starting the evening before surgery and limit water intake the morning of surgery. This is important because having a full stomach may increase the risk that your pet will vomit during or after anesthesia.

How is a vulvoplasty surgery performed?

In a vulvoplasty, your veterinarian will remove a crescent-shaped piece of tissue (skin and possibly some underlying fat) above and extending down both sides of the vulva. The size of the tissue crescent that is removed depends upon the severity of your dog’s recessed vulva. Once this tissue is removed, the cut edges of the remaining skin will be stitched together using skin sutures. This will lift the skin fold, allowing the vulva to be exposed to the air, preventing moisture accumulation.

This procedure is performed under general anesthesia.

What is the expected recovery after a vulvoplasty?

After surgery, your pet will go home with a nonsteroidal anti-inflammatory drug to prevent pain and swelling at the surgical site. It is important that you give this medication as directed, in order to keep your dog comfortable and minimize surgical complications. Your dog also may go home with an antibiotic, to prevent infection of the incision.

Your dog may have skin sutures after this surgery. These sutures will need to be removed in 10-14 days. You will need to schedule an appointment with your veterinarian to have the incision rechecked and the sutures removed at this time.

For the first two weeks after surgery, it is very important that your dog be kept calm and her activity restricted. Excessive running or jumping could cause her incision to open, leading to significant complications.

"For the first two weeks after surgery, it is very important that your dog be kept calm and her activity restricted."

It is also important that your dog wear an e-collar (cone) for the first one to two weeks after surgery. This prevents licking at the incision, which would interfere with healing and could lead to infection.

What is the prognosis after vulvoplasty?

In general, the prognosis after a vulvoplasty is excellent. Studies show that a large majority of owners are pleased with their pet’s post-operative outcome.

The most significant complication that can occur is dehiscence (opening up) of the wound. This can occur if an excessive amount of tissue is removed and the wound is closed under tension, or if a pet is excessively active in the postoperative period. Limiting your dog’s activity after surgery and using an e-collar consistently are the best ways to prevent dehiscence.

Another possible complication of a vulvoplasty is that an inadequate amount of tissue might be removed. If this occurs, the clinical signs of a recessed vulva may persist because the problem is not fully resolved. Rarely, a dog might need a second surgery to further correct the problem.

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