Episioplasty / Vulvoplasty

Episioplasty is recommended when a recessed vulva is the confirmed anatomical driver of recurrent or persistent urinary and skin problems. Indicators that surgery is appropriate include:

• Three or more UTIs within a twelve-month period despite appropriate antibiotic treatment based on culture results
• Chronic perivulvar (around-the-vulva) dermatitis — redness, discharge, odor, and skin thickening — that returns after topical treatment
• Vaginal fold pyoderma (skin infection within the fold) that does not resolve with cleaning and medical therapy
• Urinary incontinence or pooling associated with recessed vulvar conformation

In many young female dogs, the vulva is naturally somewhat recessed before the first heat cycle. Waiting until after one heat cycle or spaying is often recommended, because hormonal changes frequently cause the vulva to mature and the problem to resolve on its own. Surgery is reserved for dogs whose anatomy does not normalize with time or hormonal change, or for older spayed dogs in whom the anatomy has never improved.

Episioplasty is performed under general anesthesia with full monitoring. The procedure involves careful removal of the excess perivulvar skin fold:

• The surgeon designs the skin excision to remove the overhanging fold on one or both sides of the vulva, while preserving enough surrounding tissue to close without tension
• The skin and underlying subcutaneous tissue of the fold are excised
• The remaining skin edges are sutured together so the vulva is now exposed and flush with — or slightly prominent from — the surrounding skin
• The closure is performed in layers using absorbable sutures internally and non-absorbable sutures or staples at the skin surface

If spaying has not yet been performed, the surgical team may discuss doing so concurrently, as the hormonal environment of an intact female can perpetuate recessed vulvar conformation and recurrent infections.

Before scheduling episioplasty, the team confirms that the anatomy — not some other cause — is responsible for the recurring infections:

• Urine culture to document active infection and guide antibiotic therapy prior to surgery
• Physical examination of the perivulvar region, assessing fold depth, skin condition, and vulvar positioning
• Vaginal examination to rule out vaginal stricture, vaginitis, or other concurrent pathology contributing to the clinical signs
• Pre-anesthetic bloodwork appropriate for the patient's age
• Food withheld the night before; the perivulvar region is clipped and prepared prior to the procedure

Recovery from episioplasty is generally smooth. Home care focuses on keeping the incision clean, dry, and protected:

• Entire healing period (10–14 days): e-collar worn continuously — licking the perineal incision rapidly causes wound breakdown
• Days 1–7: mild swelling and bruising around the suture line is normal; keeping the area dry and monitoring for discharge
• Days 1–14: leash walks only; avoid sitting in wet grass or swimming
• 10–14 days: recheck visit for suture removal and assessment of healing

Antibiotics prescribed for a pre-existing UTI are continued through the recommended course. A urinalysis is rechecked at the post-operative visit to confirm the infection has cleared. Most owners see a dramatic reduction in recurrent infections within the first two to three months after healing.

Episioplasty is a well-tolerated procedure with a high success rate for reducing recurrent infections. Potential complications include:

• Wound dehiscence (incision opening) — the most common complication, usually caused by licking; the e-collar must be used consistently throughout healing
• Seroma (fluid accumulation under the skin) — typically resorbs without intervention
• Incomplete resolution of infections if there is a concurrent vaginal or bladder abnormality that was not identified pre-operatively

The majority of dogs experience a significant and lasting reduction in UTI frequency and perivulvar dermatitis after episioplasty. Owners who have managed years of repeated infections often describe the improvement as transformative for their dog's comfort and their own quality of life.