Vaginal varicose veins

Keywords: veins, varicose, equine, vagina, hemorrhage

In older mares, varicose veins occasionally develop in the vagina during pregnancy. The reason for their presence is obscure because there is no effect of gravity on vaginal veins. However, weakening of the veins with age, increased blood flow to the genitalia under the influence of estrogens and retrograde pressure due to abdominal filling during advanced pregnancy, may all be contributing causes. Under the effect of Laplace's law, these vessels grow larger with time.

Occasionally vaginal veins may rupture and become a source of hemorrhage, seen at the vulvar lips. Hemorrhage is seldom severe but it can provoke suspicions of impending abortion. Dried blood on the vulvar lips may also attract flies.

The vagina of this postmortem specimen has been everted to demonstrate the affected vessels.

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Smaller varicose veins are visible below; in the lateral wall of the vaginal vestibule in a Standardbred mare.

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Vaginal varicose veins can be up to 4 or 5 mm in diameter and are usually seen in the vestibule rather than the cranial vagina.

Numerous treatments have been described including cryotherapy, ligation and vasocontricting medications such as Preparation H ® which contains Phenylephrine in some (but not all) countries. Varicosities shrink after foaling and treatment is not required in most cases.

Contusion of the vestibule

Keywords: contusion, vestibule, foaling, equine

Even during normal foaling, there is frequently a degree of contusion of the vagina. This illustration shows contusion in the vestibule that is consistent with normal foaling.

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Optimally, one should perform a gloved hand examination of the vagina after every foaling, in the event that serious vaginal damage has occurred.

Note: The vestibule is that portion of the vagina that lies between the vulva lips and the external urethral opening.

Examination of the mare's vagina

Keywords: vagina, equine, examination

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Congenital and acquired pathology of the vagina make it essential to perform routine pre-breeding per-vagina examinations, especially when natural breeding is used.



When artificial insemination is used, vaginal defects are usually discovered when a gloved hand is inserted into the vagina during insemination.  In the case of Thoroughbreds, where natural breeding is the norm, failure to recognize structures such as persistent hymens and remnants of the mullerian system will result in breeding accidents. Such an accident (A in the amalgum image above) is shown below in image where a persistent hymen was not noted before natural breeding:

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Although a speculum examination can be used to diagnose many vaginal defects, a gloved hand examination is frequently more rewarding, especially with cervical injuries. This is because one is often able to palpate injuries when they are not obvious during speculum examinations; especially during estrus when the cervix is flaccid.. For completeness, both examinations should probably be done.

More can be seen on exit than entry during a speculum examination. This is because structures such as a partially persistent hymen or a medial wall of the mullerian system are moved to the side by the speculum and bypassed during its passage inward. These structures reveal themselves as the speculum is withdrawn,

Image B in the amalgum shows the vestibule of a mare (the region of the vagina caudal to the urethral opening) with a persistent medial wall of the mullerian system, indicated by a  two-ended yellow arrow. The external urethral orifice is indicated by a pale green ring. The urethra is very large and distensible in mares.

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Image C shows a mass of large varicose veins in the cranial vagina of an aged mare.

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This postmortem specimen shows how large these vessels can become; often causing hemorrhage that is visible at the vulvar lips. Hemorrhage often occurs during late gestation or during estrus under the effect of high serum estrogen concentrations. In such cases, owners must be assured that this is not a sign of impending abortion.

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Image D shows an intact hymen, bulging through the vulvar lips in this mare in lateral recumbency. The mare was under general anesthesia when this image was taken. causing the hymen to twist on its dorso-ventral axis, with the medial wall of the mullerian system providing a central raphe to the structure.

Although persistent hymens are more common in heifers than maiden mares, persistent or partially persistent hymens are common enough to warrant routine vaginal, pre-breeding examinations. Occasionally a complete hymen can become so stretched (presumably due to changes in intra-abdominal pressure) that it may cover a fully inserted speculum or extend,  sock-like, through the vulva lips.