THIRTY-FIVE: Vaginal and Preputial Discharge

Clinical Vignette


A 9-month-old female Labrador retriever is presented for vaginal discharge. The owner reports finding bloody spots on the floor and the dog is constantly licking the vulva. Physical examination reveals a very healthy and energetic dog. The vulva is swollen and turgid and a hemorrhagic vaginal discharge is present.


Using the problem-oriented approach described in Chapter 1, identify the problems in this dog and write an initial plan for each problem.


Problem Definition and Recognition


Vaginal and preputial discharges are commonly seen in dogs and infrequently in cats. Vaginal discharges may be normal or abnormal, as they are often associated with the estrous cycle of the bitch or queen. Preputial discharges are typically considered abnormal, although a small amount of purulent preputial discharge is so common among male dogs that it is practically considered a variation of normal. Due to the fastidious nature of cats, discharges in either sex are not commonly observed. Preputial and vaginal discharges may arise from either the urinary or reproductive tracts. They are classified as hemorrhagic, purulent, or mucoid.


Hemorrhagic discharge is a normal characteristic in the bitch during proestrus and may persist variably through estrus in some females. This discharge is typically more hemorrhagic during proestrus and thins to become more serosanguinous during late proestrus and estrus. Discharge ceases altogether as the bitch enters diestrus. Confirmation that the discharge is a normal part of the estrous cycle may be realized by performing a vaginal cytology.


Purulent vaginal discharges are yellow or reddish brown, and sometimes have a foul odor. They are characterized by the presence of polymorphonuclear cells (PMNs) that are a result of inflammation of the genitourinary system. Purulent discharge is a normal finding in a bitch in early diestrus. In this case, the discharge may be fairly thin and straw colored, with a large number of white blood cells seen on cytology. This is characteristic of the first several days of diestrus, after which time all vaginal discharge should cease. When diestrus occurs, the bitch will commonly refuse to be mounted by the male, and no clinical signs are exhibited by the bitch during this time.


An occasional light mucoid discharge (greenish yellow) is normal at any time in both the pregnant and nonpregnant females. A heavier mucoid discharge may be normally seen in diestrus, late pregnancy, and postpartum. Mucus is the predominant component of the lochia (normal postpartum discharge) that is seen for up to 6 weeks postpartum. A heavy persistent mucoid discharge should be further investigated via a thorough vaginal examination.


TABLE 35-1. Vaginal discharges



















Type of Discharge Characteristics Common Causes
Hemorrhagic Bloody, serosanguinous Proestrus, neoplasia, impending abortion, post-whelping lochia, SIPS
Purulent Yellow or reddish brown; may be malodorous, PMNs present; bacteria may be present Early diestrus, septic vaginitis, urinary tract infection, neoplasia, juvenile nonseptic vaginitis, metritis, pyometra
Mucoid Clear to slightly greenish yellow tinged Normal, light mucoid discharge

Table 35-1 lists the characteristics of vaginal discharges including those associated with the estrous cycle.


Diagnosis


Physical Examination


The minimum database includes a complete history, a thorough physical examination (including vaginoscopy in the case of vaginal discharge), and cytologic analysis of the discharge. It is important to determine the female’s stage of estrous, her pregnancy status, and when her last estrus was observed. The age and overall health of the animal should be established, taking note of any other systemic signs of disease or any changes in activity level or attitude. The owners should be encouraged to be especially descriptive of the amount, duration, and appearance of the discharge, including the age of the animal when the discharge was first noted and any change in the character of the discharge over time (see Table 35-1).


In conjunction with a complete physical examination, the entire reproductive tract should be thoroughly examined (sedation may be required). In the male, the penis, prepuce, and urethra should be palpated, and the penis should be extruded for a visual examination. Rectal palpation of the prostate gland is a critical part of the physical examination of any male dog. Use of one hand to apply upward pressure to the caudal abdomen can facilitate the complete digital examination of the prostate. In the female, the vaginal vault should be visually examined via vaginoscopy as well as digitally palpated. Vaginoscopy can be accomplished through the use of a vaginal speculum or an endoscope (sedation may be required). A vaginal speculum (a human pediatric proctoscope has a built-in light source and works well) is ideal for larger (>20 kg) bitches. This instrument reveals a large field of view, providing a thorough examination of the vagina. A flexible or rigid endoscope may also be used to visualize the vagina, and this is satisfactory in smaller bitches (<20 kg) that are not large enough to allow use of the speculum. It is often helpful to perform a digital examination of the vagina in conjunction with vaginoscopy to adequately identify vaginal strictures or an imperforate hymen.


Cytological Evaluation

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May 25, 2017 | Posted by in SMALL ANIMAL | Comments Off on THIRTY-FIVE: Vaginal and Preputial Discharge
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