Jini Ghosh¹, Parishmita Das¹, Hunmili Ronghangpi¹ and Mohua Das Gupta^2*

Department of Animal Reproduction and Gynaecology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781 022

¹M.V.Sc. scholar; ²Assistant Professor

*Corresponding author, email: mohua.dgupta@gmail.com

What is hyperplasia?

The word hyperplasia is derived from the Greek words “hyper”, meaning excessive, and “plasia”, meaning formation or growth. In simple terms, it refers to the abnormal enlargement of tissues or organs due to an increased number of cells.

In dogs, vaginal hyperplasia is most commonly observed in unspayed females, especially during the follicular phase of their heat cycle. It’s often mistaken for more serious conditions such as vaginal tumours, transmissible venereal tumours (TVT), or venereal granulomas. However, vaginal hyperplasia specifically occurs when the vaginal tissue becomes swollen and may protrude through the vulva, typically during the proestrus or oestrus phases-collectively known as the “heat” period.

The protruding tissue usually appears smooth, moist, and uniform in texture. This condition is also known by several other names, including vaginal fold prolapse, oestrus hypertrophy, vaginal eversion, or vaginal protrusion. It primarily affects intact (unspayed) female dogs because they produce higher levels of oestrogen, the hormone that triggers the development of hyperplasia. Elevated oestrogen levels cause excessive folding of the vaginal lining, especially in the area just in front of the urethral opening. This folding can displace the urethral orifice, pushing it toward the surface of the swollen tissue. Additionally, oestrogen increases blood flow (a condition known as hyperaemia) and leads to swelling (oedema) of the vaginal tissue, particularly during oestrus or even in the later stages of pregnancy (Antonov et al., 2023).

Types of Vaginal Hyperplasia:

Vaginal hyperplasia is categorized into three degrees based on severity:

• Type I: Mild swelling or eversion of the vaginal floor, but no tissue protrudes beyond the vulva.
• Type II: Moderate prolapse where the vaginal tissue extends out through the vulva, appearing as a pear-shaped mass.
• Type III: Severe prolapse where the entire vaginal wall protrudes, forming a doughnut-shaped mass with a central opening.

                                                    .  

                                                      Figure: Type -1                                Figure:  Type- III

At the Veterinary Clinical Complex (VCC) in College of Veterinary Science, Khanapara, the cases of complete vaginal prolapse presented for examination typically appear as round, tongue-shaped, or doughnut-like masses protruding visibly from the vulva. These tissues are usually smooth and shiny in appearance. While dogs with vaginal hyperplasia can still conceive, breeding is generally discouraged if the condition is congenital (present from birth). This is because the prolapsed tissue may obstruct the birthing process, increasing the risk of complications during delivery and potentially requiring emergency intervention. Some affected dogs may also experience difficulty in urination. In pregnant females, true vaginal prolapse can develop in the later stages of gestation, often causing discomfort. This usually occurs when progesterone levels drop and oestrogen levels rise in preparation for labour, leading to increased pressure and swelling of the vaginal tissue.

Commonly Affected breeds:

While any unspayed female dog can develop vaginal hyperplasia, certain breeds, especially brachycephalic (flat-faced) breeds, and certain age (<2 to 3 years of age) are more prone (Krishnan et al., 2014). These include:

• German Shepherd
• Boxer
• Labrador Retriever
• Mastiff
• Airedale Terrier
• Springer Spaniel
• English Bulldog
• Walker Hound
• French Bulldog

Confirmation of vaginal hyperplasia by the following:

• Clinical examination reveals a complete circumferential prolapse of the vaginal wall, visible through the vulvar labia, giving the exposed tissue a characteristic “doughnut” appearance.
• Vital parameters, including rectal temperature, heart rate, and the appearance of the conjunctival mucous membranes, are within normal limits.
• Vaginal cytology confirms the presence of predominantly cornified epithelial cells along with a few intermediate cells. Vaginal swabs are gently introduced, rolled inside the vaginal canal, then transferred onto clean slides and stained using Giemsa stain for microscopic evaluation (Ajadi et al., 2016).
• A serosanguineous (blood-tinged) oestrous discharge is observed from the vaginal opening.
• The dog exhibits typical oestrous behaviour.

Diagnosis and Treatment of Vaginal hyperplasia in dogs:

Vaginal hyperplasia is diagnosed based on a combination of clinical signs and diagnostic procedures. One of the most characteristic findings during physical examination is the presence of a round, protruding mass with a “doughnut-like” appearance, where the entire circumference of the vaginal wall is exposed through the vulvar opening. Despite the noticeable protrusion, the dog’s vital signs, such as rectal temperature, heart rate, and conjunctival mucous membrane colour, typically remain within normal limits. Therefore, to confirm the condition, vaginal cytology is performed. A sterile swab is gently inserted into the vaginal canal and then rolled onto a clean microscope slide. After staining, typically with Giemsa stain, the sample reveals predominantly cornified epithelial cells along with a few intermediate cells, findings consistent with the oestrus phase. Additional signs that support the diagnosis include the presence of serosanguineous (blood-tinged) vaginal discharge and typical oestrus behaviours, such as mounting, flagging, and increased receptivity to mating.

In many cases, vaginal hyperplasia resolves on its own as the oestrus cycle progresses and oestrogen levels decline. However, supportive management is often recommended, and an Elizabethan collar (E-collar) may be used to prevent the dog from licking or traumatising the swollen tissue (Galal et al., 2018). If the prolapse is small, gentle manual reduction may be attempted after thoroughly cleaning the area and applying a sugar or dextrose solution to reduce swelling. In cases where the tissue has been successfully reduced, purse-string sutures can be placed to prevent recurrence during the same cycle. On the other hand, for bitches that have not yet ovulated, ovulation can be hormonally induced using human chorionic gonadotropin (hCG). Alternatively, Megestrol acetate, a synthetic form of progesterone, may be administered during early proestrus to suppress excessive estrogenic activity and prevent hyperplasia. In recurring or severe cases, especially in non-breeding dogs, a complete ovariohysterectomy (spaying) is often the most effective long-term solution. If the prolapsed tissue interferes with natural delivery, a caesarean section (C-section) may be necessary to safely deliver the puppies.

Surgical management:

When surgical removal of prolapsed vaginal tissue is necessary, the procedure is performed under general anaesthesia. The dog is initially premedicated with Atropine sulphate (0.04 mg/kg body weight) administered subcutaneously and Xylazine (1.0 mg/kg body weight) given intramuscularly as a muscle relaxant. Anaesthesia is then induced intravenously using a combination of Ketamine (5 mg/kg) and Diazepam (1.0 mg/kg). The dog is placed in lateral recumbency, and the protruding mass is gently cleansed with sterile saline. To avoid injury during surgery, the external urethral opening is identified and catheterised. The oedematous (fluid-filled) prolapsed tissue is then ligated with absorbable sutures, taking care not to include the urethra. Once the ligation is secure, the affected tissue is surgically excised (amputated) (Antonov et al., 2009).

Post-Operative Care:

After surgery, the dog requires a structured regimen of medications and wound management to promote optimal healing:

1. Intacef Tazo (20 mg/kg body weight, intramuscularly) – administered twice daily for 7 days as an antibiotic.
2. Meloxicam (0.2 mg/kg body weight, intramuscularly) – given once daily for 5 days to manage pain and reduce inflammation.
3. Pantoprazole, administered intravenously once daily for 7 days, is used to protect the gastrointestinal tract during the recovery period.
4. Deep TBR tablets – One tablet orally, twice daily for 5 days to provide nutritional support and boost the immune response.
5. Wound care – the surgical site should be regularly cleaned and dressed with Betadine solution and Mupirocin ointment until complete healing is achieved.

References:

Ajadi, T.A.; Ajayi, O.L.; Adeniyi, A.A. and Ajadi, R.A. (2016). Vaginal wall hyperplasia with fold prolapses in an eight-month-old Cane Corso dog. Bulgarian Journal of Veterinary Medicine. 19(3): 252-258. DOI: 10.15547/bjvm.917.

Antonov, A.; Atanasov, A.; Fasulkov, I. and Karadaev, M. (2023). Clinical retrospective study of vaginal hyperplasia in the bitch (2012–2022). Reproduction in Domestic Animals, 58(10): 1352-1358.

Antonov, A.L.; Atanassov, A.S. and Georgiev, P.I. (2009). A modified technique for prolapsed fold excision in a bitch with vaginal hyperplasia. Bulgarian Journal of Veterinary Medicine. 12(4): 260-264.

Galal, S.M.; Fathi, M.; Ismail, S.T.; ElBelely, M.S. and Mohamed, F.F. (2018). Clinical diagnosis and surgical approaches of vaginal hyperplasia in bitches. Asian Pacific Journal of Reproduction 7(5): 220-224.

Krishnan, M.G.; Nagarajan, I. and Arunaman, C.S. (2014). Surgical management of vaginal hyperplasia and prolapse in a pug bitch. Indo-Am. J. Agric. Vet. Sci. 2: 3-7.

Download PDF