Episioplasty

Depositphotos_24063241_sEpisioplasty is a surgery done to correct a recessed or hooded vulva on a female dog. Episoplasty (also known as vulvoplasty) removes excess folds of skin that cover the vulva (the external genital organs of the female dog). The procedure does not alter the genitals, but rather creates a more normal position for the vulva which should not be covered by skin.

This excess skin can be due to obesity, which leads to too much fatty or skin tissue folding over the vulva. It can also be found in pets who were spayed before coming into heat for the first time. For some females, going through their first 1-2 heat cycles allows for natural enlargement and swelling of the vulva. In some cases, the excess tissue has no apparent cause and is simply part of the way your pet is “built.” This is particularly true for certain breeds such as English Bulldogs, French Bulldogs, Boston Terriers, Shar Pei’s, and Pugs, but other breeds can also be affected.

Keep in mind that if the excess of skin is due to obesity, putting your pet on a diet is highly recommended but will not solve the problem of a hooded vulva, as the skin folds will likely remain in place over the vulva even if your pet loses excess fat.

When is Episioplasty Necessary?

Not all dogs with an excess of skin over the vulva have problems. Some might live with it all their lives and never need surgery. In many dogs, however, these folds of skin create a perfect environment for the growth of bacteria and yeast, especially since the area can stay moist constantly as your pet urinates, sweats, or licks the area. The urine and moisture then become trapped in the folds, preventing the skin from drying naturally.

This moisture often leads to skin irritations, inflammation, loss of hair, discolored skin and hair, and burning and itching in the area on and around the vulva. Typically these symptoms are worsened in dogs with underlying allergies that further compromise the skin around the vulva. Bacteria trapped around the vulva can also find its way into the urethra and the bladder, leading to problems such as recurrent urinary tract infections. In some cases, this can even lead to life-threatening, painful kidney infections.

Early detection occurs during each puppy exam when the vulva should be checked by your veterinarian, especially for susceptible breeds, to determine if additional recommendations need to be made. At this stage, if your puppy has not been spayed, it may be a reasonable option to allow her to go through one to two heat cycles to see if this can create some natural swelling and enlargement of the vulva so that it is not tucked or hooded. If this is not an option and the vulva is recessed enough to cause concern or there are already signs of peri-vulvar irritation, an episioplasty can be performed prophylactically during the spay procedure.

Signs and Symptoms

The need for episioplasty is not always obvious to pet owners. However, it should be part of every complete physical exam for your vet to check the area around the vulva and determine if the skin there is normal or whether there are extra skin folds that might be causing a problem.

Once inflammation or infection is already present, you might notice your pet exhibiting signs such as frequent urination, rubbing the hind end on the floor, discharge from around the vulva, odor in the back end of your pet, or licking the area constantly. Pets that are housebroken might start having urinary accidents because they feel the need to urinate constantly or are not able to hold urine. This is known as “urinary urgency,” or the need to urinate even if there’s little urine present in the bladder.

If you have a female dog that has frequent urinary tract infections with no obvious explanation (such as an internal problem that could be causing them), the excess of skin could be the reason. In that case, your vet might conduct a series of tests to check for a female dog UTI, including a urine culture, blood and urine tests to check kidney function and an abdominal ultrasound to check the kidneys and bladder. This will rule out other problems that could be causing the frequent UTIs. If no obvious internal underlying cause is found for your dog’s recurrent urinary tract infections, she might be a good candidate for an episioplasty.

What Does the Surgery Involve?

Before your pet undergoes an episioplasty, she will need to undergo a series of tests. At a minimum, a blood panel and urinalysis are required. This will confirm that your pet is healthy enough for surgery.

During an episioplasty, the folds of skin surrounding and covering the vulva are removed. We will remove a measured section of excessive skin in a horseshoe-shaped pattern. This helps expose the vulva and eliminates the folds that were originally covering it. The incision is then sutured and allowed to heal.

During recovery, your pet will need to wear a collar at all times and be kept indoors (except for short walks) to prevent licking and to ensure the area of the incision remains clean until the sutures are removed approximately 2 weeks post surgery. It is common for your dog to want to scoot and rub her rear end after surgery, but she cannot be allowed to do this and may need to be confined to a small crate where she cannot rub or disrupt the sutures.

Although the surgery is not considered major (since there’s no access to major organs), pain, inflammation and infection are still possible if you don’t care for the area properly. Detailed instructions will be provided and discussed upon discharge from the hospital. To ensure your pets utmost comfort during her recovery, she will receive pain medication and prophylactic antibiotics.