The female reproductive system includes the ovaries, uterus, vagina and external genitalia as well as the mammary glands that produce milk for kittens. Diseases affecting the system are included herein, as well as information regarding pregnancy and nursing of kittens.

Female cats are unique in that they do not have heat cycles twice yearly, as do dogs. Rather, they are seasonally polyestrus meaning that they start into heat when the days lengthen and stop cycling when the days become short. If a cat is not bred, she will cycle in and out of heat every 2-3 weeks for a good portion of the spring and summer in most locales. Also unlike the dog, the female cat will not ovulate until it is bred. Tiny spikes or spines on the male cat's penis will stimulate ovulation at the time of breeding.

During the active or estral part of the heat cycle the female cat will usually howl, twist and curl itself about lovingly and hold the rump in the air with the tail to the side as if to desire mating. This often is enough to drive most cat owners to the veterinarian to have the cat spayed. There usually is not vulvar swelling or bleeding as appears in the dog. It should be noted that for the period of time the cat is not showing these obvious outward signs, she would still be in heat internally until the season has ended.

Probably the most common disorder seen in intact female cats, pyometra is a serious and life threatening infection of the uterus. Due to hormonal and uterine changes that occur in the older cat, an infection can start in the uterus and lead to death due to sepsis or organ failure if not treated properly. (see cystic endometrial hyperplasia) It is also possible in a very few spayed cats for the small piece of uterus, usually left during spaying, can become infected.

The symptoms are most common in cats over 8 years old unless the cat has been given hormones for a medical abortion, in which case any age cat can be affected. Usually a few weeks after a heat has occurred, symptoms will begin. The symptoms observed outwardly, however, will depend on whether the cervix is open or closed.

In cases of Open-Cervix Pyometra a thick, bloody and pus-like vaginal discharge is noted. The cat will often be lethargic, weak, loose their appetite, loose weight, drink and urinate more frequently and may vomit or have diarrhea. If the cervix is closed, no discharge will be seen, but other symptoms will include abdominal enlargement, shock and coma. 

Diagnosis is based on history, especially the fact that the female is not spayed (in most cases), analysis of vaginal discharges, culture, blood counts, serum chemistries, urinalysis, X-rays and ultrasound studies. This disease is serious and requires prompt and aggressive treatment.

All cats should be stabilized with IV fluids, antibiotics and general supportive care. The best treatment is to perform surgery as quickly to remove the uterus and ovaries (similar to a spay, but quite a bit more complicated) before any pus can leak into the abdomen. If the uterus remains in one piece and no organ damage occurs, the success rate is excellent. Where the uterus ruptures, the chances for survival are poor, as peritonitis is a serious complication. The most common organ dysfunction is kidney failure.

Some persons, especially cat breeders, may hope to retain the reproductive capabilities of the queen. If the uterus is draining naturally, the use of a drug call prostaglandin F 2-alpha along with heavy antibiotic therapy may be employed. While this type of therapy does provide an option, it is advised only for selective cases, as there are many risks inherent to the procedure and the drug itself. Our advice is, for most cases, surgically remove the affected organ and enjoy the cat.

While uncommon, there is a limit to how far the uterus can stretch. In some advanced cases of pyometra or dystocia, these limits may be exceeded and the uterus ruptures. If a pyometra ruptures, severe peritonitis and septic shock will ensue and the patient may die quickly without emergency care. If the uterus ruptures during labor, then kittens may be "born" into the abdomen and peritonitis will also begin. Prompt attention in either case is essential. Clinical signs include abdominal pain, collapse or extreme weakness, rapid respiration and shock. Diagnosis is based on history, physical examination, X-rays, aspiration of abdominal fluids and exploratory surgery.

While it may be possible to repair a ruptured uterus, the best course under most circumstances will be to remove the organ. If the cat is in labor, performing a modified C-section first is necessary to save the kittens. With the uterus removed, the abdomen is cleaned and flushed many times, treated with antibiotic solutions and closed with or without some type of external drainage. Antibiotics and general supportive care will generally allow most cats to recover.

On occasion the uterus may become twisted in the later part of pregnancy. The cause of this is unknown. Clinical signs include dystocia, bloody vaginal discharge, abdominal enlargement, abdominal pain and generalized weakness. Any fetuses will usually be dead at the time of diagnosis. It is often difficult to differentiate this condition from that of a pyometra unless skeletons are clearly visible on X-rays. Diagnosis is based on history, physical examination, blood counts, serum chemistries, X-rays and ultrasound.

IV fluids, antibiotics and ovariohysterectomy should save the mother but kittens will generally be dead. No other treatment is advised.

Metritis is a bacterial infection of the uterus, but unlike pyometra, it progresses rapidly and severely to cause sepsis, an infection that spreads in the blood. The problem always occurs soon after the birth of kittens, usually within 1-week post-partum. Infection can enter the uterus directly from the outside; it can be initiated by placental parts left in the uterus, by pieces of or whole kittens being left inside the uterus, from trauma due to dystocia or due to medical intervention.

Symptoms include a foul smelling vaginal discharge, weakness, loss of appetite, vomiting and poor milk production. The patient will often be dehydrated, have a high fever and be very lethargic. Many cats go into shock and collapse. Diagnosis is based on the history, physical examination, vaginal cytology, vaginal cultures, complete blood counts and serum chemistries, X-rays and ultrasound analysis. This disease can be prevented in most cases by having females checked after queening and by giving a "clean out" injection to expel debris and shrink the uterus.

Rapid attention is highly recommended. IV fluids and IV antibiotics are used to stabilize the patient. Injections of oxytocin to help evacuate the uterus are often used. In some cases infusion of antibiotics directly into the uterus or surgically removing the uterus may be needed along with long-term oral antibiotics. Unfortunately, most cats developing acute metritis will no longer be able to sustain their kittens, a task the owner may have to assume.

CEH is an abnormal thickening of the uterus including the formation of cysts, increased glandular activity and an infiltration of certain types of white cells into the uterine lining. This condition becomes more common as the female ages and may produce no serious disease for the pet. Nevertheless, the condition can predispose the cat to endometritis, pyometra and other less serious types of infection. No treatment for this condition is needed per se, but again, spaying all cats not used for breeding is highly advised.

In some cats, one or both sides of the uterus may fail to develop. Sometimes a part of the uterus will be underdeveloped. Depending on the degree of improper development, fertility may be affected. Most often, the disorder is diagnosed when the veterinarian is spaying the cat; otherwise diagnosis is difficult. The problem will cause no harm in most cases except where fertility has been affected. ((Aplastic Uterus))

When the uterus or part thereof, turns inside out and protrudes through the vagina, a prolapse occurs. The condition is rare in cats. It occurs most often after queening, especially if there have been difficulties with the birth process. An actual cause has not been determined.

Diagnosis is usually simple, based on seeing the uterus protrude, but other clinical signs may include straining, pain, restlessness, trouble moving, bleeding, shock, fever and vomiting. Other than direct examination, X-rays, blood counts and serum chemistries may all be needed to determine if this is the only problem.

Treatment will depend on the condition of the animal as well as the condition of the prolapsed uterus itself. The first concern will be to stabilize the patient with fluids, electrolytes and other medications as needed. In some cases, the uterus can be directly replaced under anesthesia. In other cases, the uterus may be surgically removed from outside the body or replaced and then surgically removed. Antibiotics and oxytocin are also used to help promote healing.

Several different types of ovarian cysts can form in the cat from ovarian tissue or the actual egg-forming process. Most, which usually form in older cats, are small and insignificant. Most produce no reproductive abnormalities. Some grow large and cause mild abdominal pain. One type, the follicular cyst, can create clinical signs. ((Ovarian Cysts))

These symptoms would include heat cycles without receptivity to the male, altered heat cycles, failure to come into heat on a regular basis and twisting of the uterus. Diagnosis is based on history, clinical signs, hormone analysis and pathology of cysts discovered at surgery.

Cats showing the above clinical signs or having cysts otherwise confirmed or suspected should be spayed. No other treatment is available.

Vaginitis is inflammation of the vagina, which can be caused by a bacterial infection, mycoplasma or herpesvirus. This condition is uncommon in cats. The main clinical signs are a pus-like discharge, licking of the genitals, attraction of male cats, a foul odor and swelling of the vulva.

Vaginitis can occur due to defects in vaginal structure, foreign objects, a weak immune system often seen in young and immature kittens and lower urinary tract infections. Cats that appear to have vaginitis may instead have an open pyometra. Diagnosis is based on physical findings, vaginal cytology, urinalysis, blood counts, culture of vaginal exudates, X-rays and ultrasound. ((Vaginitis))

If there is an obvious predisposing cause of the vaginitis such as a foreign object, that should be corrected first. Oral antibiotics plus twice-daily douches with disinfectant solutions are most commonly used. Long-term treatment is required in some cases as the infections can be moderately resistant to treatment. Kittens may improve the most as they get closer to puberty.

INTERSEX DISEASES

HYMENAL REMNANTS, thin bands of tissue that restrict the vaginal opening, may be corrected with surgery.

RECTOVAGINAL FISTULA is an abnormal connection or communication between the rectum and vagina where separate walls failed to completely form. Fecal material may come through the vagina. This may be corrected with surgery.

HYPOPLASIA is an abnormal vaginal narrowing which may preclude breeding; most commonly cats are spayed and live normally.

Any female cat that does not want to be bred, fails to conceive when bred, or fails to carry a litter to term is said to be infertile. Much of this type of problem relates to extensive inbreeding and/or poor selection or use of breeding cats over time. As with male infertility, the causes of female infertility can be quite numerous: hormonal imbalances, uterine dysfunction, FeLV, FIV, genetic defects, endocrine disease, infections and so forth.

History will be important to ferret out the cause of any breeding failures. When did the cat first have a heat? Have the heat cycles been regular and normal? Has she been bred before and with what results? Has she ever been pregnant and delivered a litter? These questions will put the veterinarian on the right course to proper diagnosis.

Besides history, physical examination, vaginal cytology and culture, blood counts and serum chemistries, urinalysis, hormone analysis, leukemia and FIV testing and ultrasonography may all be used to achieve a final diagnosis. Treatment will depend on the final accurate diagnosis. Any person serious about resolving a fertility problem will need to fund a complete and thorough diagnostic work-up. It cannot be forgotten that failure to conceive can be a problem involving the male cat and not the female.

On occasion, with or without breeding, a female cat can appear to be pregnant outwardly without any kittens present internally. Why this occurs is not well understood, except we can say that the end stage of a normal heat cycle, known as the luteal phase, lingers, or fails to terminate as quickly as it should. This causes progesterone levels in the blood to remain high, literally tricking the queen's body into believing that kittens are present. When the luteal phase ends, the mother may show maternal behaviors towards toys or other objects or even produce milk.

Clinical signs include maternal behaviors such as mothering toys and nesting, loss of appetite, enlargement of the mammary glands with discharge, to which, on occasion, a mastitis can occur. Normal kittens will not be present. Diagnosis is based on history and physical examination in most cases.

There is some debate as to whether or not to treat this condition. Consensus is that if the cat has extreme behavioral changes or mammary disease, treatment should be given. Treatment may also be given just to relieve the associated discomforts. Female hormones, cortisone to relieve breast swelling and hot packs on the mammary glands will provide relief. Spaying the cat will be curative as the problem will most often otherwise recur.

Disorders or defects of the mother, kittens or placenta can all result in termination of pregnancy. Uterine disease, ovarian disease, fetal deformities or defects, infections including feline leukemia virus, feline infectious peritonitis, feline immunodeficiency virus, feline herpes virus, toxoplasmosis, salmonellosis, certain drugs and abdominal trauma can all result in spontaneous abortion.

Clinical signs may or may not be observed other than no kittens being born when expected, depending upon the stage at which a given pregnancy was ended. Discharge or passing kittens or parts of kittens prematurely may be observed. Fever, loss of appetite, vomiting and diarrhea can all occur. Diagnosis includes observation of clinical signs, X-rays, ultrasound, analysis of discharges, blood counts, FeLV, FIP and FIV testing, fecal analysis and other serologic testing where appropriate. Acute metritis and pyometra would be common post-abortion side effects.

While little can usually be done after the fact, cats should receive medications to clean out the uterus, antibiotics to prevent infection and spaying if it seems preferable to no longer breed the queen. It is important to obtain a proper diagnosis, as again, some causes of spontaneous abortion are communicable and need aggressive treatment to stop their spread.

Veterinarians are sometimes asked to terminate pregnancy either because breeding was unintentional or because the female bred may be ill suited to carry a litter. As a general rule, pregnancy termination by medical means should take pace very soon after breeding rather than later. Female hormones, PGF2-alpha and cortisone medications have all been used but none is 100% successful. Furthermore, side effects including pyometra and damage to bone marrow can occur in a small percentage of cases. Spaying of any cat at almost any stage of pregnancy is always 100% successful in preventing any unwanted kittens.

Dystocia defines difficulty in giving birth or as more commonly used, trouble in getting the kittens out of the mother. This can occur for several reasons ranging from problems with uterine function, obstructions and fetal defects. Dystocia is uncommon in the cat. To properly understand dystocia, we must first describe how a normal delivery should progress.

Normal delivery, or parturition, is generally divided into three distinct stages. The first stage actually occurs before any labor has begun. In this stage, cats will start to look for and/or build their bed or nest in preparation for the delivery. Their behavior may seem quite nervous or unusual and most will refuse food and water. The breasts will enlarge and should begin to have early milk production. A thick white gelatinous mucoid material will be passed vaginally about 48 hours prior to delivery.

The actual process of delivery or labor characterizes stage two. Contractions and straining begin and usually a membrane, which appears as a fluid filled bubble at the opening to the vagina, often followed by passage of a green-black placental sac. Then, more forceful efforts to expel a kitten begin. Kittens are generally passed within one hour of each other although intervals as long as 24 hours have been reported.

The third phase of labor consists of delivery of placental parts, a rest phase of 10 minutes to an hour while the mother removes membranes and cleans the kitten and then repeating stage two and three until all kittens are born. The normal interval between births is 30-60 minutes, although with larger litters, several may be born, followed by a longer rest, then another few. Sometimes 2 kittens are born followed by a longer rest. All would be considered normal and many patterns of delivery will be acceptable. Also, kittens are normally born face or feet first so no need to panic.

The question is always asked, "How do I know when the mother is done?" Suffice it to say that when labor stops, she is done. Irrespective of that, the best way is to have had good prenatal examinations of the mother, including an X-ray or ultrasound analysis at about 45-50 days of term so that the number of kittens present can be clearly known. Also, females should be checked 24-48 hours post-partum by your veterinarian to look for any undelivered kittens as well as to give an injection to assist expulsion of any other retained materials.

Problems relating to the mother are the most common cause of feline dystocia. Small pelvic openings or pelvic size compromised by pelvic fractures or soft tissue growth will limit kitten expulsion. Mothers bothered too much by over-interested owners will also have trouble. Twisting or tearing of the uterus will cause severe and life-threatening problems. The most common maternal difficulty, however, is known as Uterine Inertia.

Uterine Inertia literally means that the uterus cannot push anymore. Primary uterine inertia occurs often before any actual second stage labor begins. The reasons for this include advanced age of the mother, few kittens in a large cat, low blood calcium levels, low blood sugar, low hormone levels, dead kittens, genetic disorders, obesity, or poor maternal condition in general.

Secondary Uterine Inertia occurs most often after a long labor and delivery process either due to exhaustion of the mother or greatly decreased calcium levels (from all that work being done)! Failure to fully expel a kitten can also result in this difficulty.

An uncommon cause of dystocia is that of fetal (kitten) malpositioning or head-size variations that blocks delivery. Oversized kittens from small litters in small cats may have trouble coming out. Although common in the dog, these situations are scarce in the cat.

The clinical signs of dystocia, also known as "When To Get Help", include being in second stage labor for 3-4 hours without a kitten being born, more than 2 hours between kittens, the mother seeming to be in increased distress while in labor; excess bleeding or a foul smelling discharge being passed, a female that is 63-68 days post breeding without delivery having occurred and more than 4 hours passes between births (assuming more kittens are present). Diagnosis is based on historical information, physical examination, X-rays and ultrasound studies.

Treatment will depend upon the cause of the dystocia. To season that, the health of mother and kittens may dictate the course of therapy even more so. Some cats will benefit from administration of oxytocin and calcium containing fluids that will literally restart the delivery. Some cat breeders, however, mistakenly administer multiple oxytocin injections on their own and often endanger the health of mother and kittens. We, therefore, strongly advise against this type of arbitrary therapy.

Sometimes, in cases of minor malpositioning, genital manipulation and lubrication can allow delivery and bring forth the kittens without surgery. In many cases, however, a cesarean section will be the only alternative. The decision to perform a cesarean section should not be delayed and the health of mother and kittens as well as the likelihood of other therapies to be successful must all be taken into account. 

Eclampsia is a condition of low blood calcium, which usually occurs 1-3 weeks after queening; rarely it is seen a week or so before birth of the kittens. The cause of this condition is unknown, although the high demand for calcium used during labor or for milk production and an inability of the queen to maintain that level ultimately produces the condition. As a general rule, calcium supplements should not be given to females until the birth actually occurs and then only during the nursing process.

Clinical signs include nervousness and slight muscle tremors and/or trembling. An inability to deliver kittens (dystocia) can also be a sign of low blood calcium. This may progress to staggering, muscle spasms and seizures, along with a greatly elevated body temperature, respiratory distress and death. This advanced form is, however, very uncommon in the cat. Diagnosis is based on history and these clinical signs as well as determination of blood calcium levels. Treatment is usually begun based on only the symptoms present.

Immediate therapy is required to save eclamptic cats. IV fluids with a slow but significant level of bioactive calcium are given first. Treatment for the increased body temperature and careful patient monitoring is critical. Once the patient is stabilized and has returned to normal, the possibility of continued nursing must be evaluated. Some cats can nurse with increased caloric intake and calcium supplementation orally. Other times, kittens must be removed from the mother, hand raised and the mother given oral calcium supplementation for 10-14 days. Eclampsia is likely to occur with subsequent pregnancies.

Mastitis is an infection of the mammary glands, or breasts of female cats, most common while nursing kittens or in cases of false pregnancy. Bacteria enter into the breasts through open nipples and spread through the porous mammary tissues. Trauma from nursing and poor sanitary conditions most commonly contributes to the condition. Some older cats may have chronic but less severe cases of mastitis.

Clinical symptoms include one or more breasts being swollen, red, painful and warm. Fever and depression of the mother are common and kittens may also be weak and dying from the toxins in the milk. Abnormally colored milk and/or discharges may be present. In some cases large abscesses which rupture and rot will come about and cats may be outwardly much more ill. Diagnosis is based on history, physical examination, blood counts, milk cytology and cultures. This author recommends a culture always be performed because of the severity and difficulty killing the infections usually present. ((Mastitis))

Although antibiotics are needed, more often very potent and high quality medication will be required and should be based on culture results. Milking any affected glands is important. Kittens can be allowed to nurse if kept away from infected glands. Hot packs and good hygiene are important to help healing and control the spread of infection.

Where breast tissue has abscessed and ruptured drainage of the abscess and surgical removal of rotting tissues under sedation will be needed. In some cases a drain will be placed in the wound and topical medications as well as oral antibiotics will be needed. Badly damaged glands or glands which have had multiple infections should be surgically removed. If the infection has spread to the blood stream, IV fluids, antibiotics and hospitalization is needed until control of the infection is obtained.

Mammary hyperplasia is a benign process peculiar to the cat. When it occurs, the breast tissues will rapidly enlarge, swell and harden to some degree. The degree of enlargement is usually more so than would be seen in the nursing queen and occurs most commonly in young females just after the heat cycle ends. It has also been observed in males and spayed female cats receiving progesterone-type drugs. Many cat owners will mistake the swelling for some type of infection or tumors of the breasts. ((Mammary Hyperplasia))

Clinical signs include swelling to the breast, which is often quite hard, firm and nodular. A few to all the glands may be involved. A brown fluid may be expressed from the nipples. There usually is minimal pain and cats are often quite normal otherwise. Diagnosis is based on history, clinical signs, fluid cytology and in some cases, breast biopsy.

Many cases may resolve without treatment. The use of testosterone, dexamethasone and spaying the cat usually helps hasten glandular shrinkage. The use of hot packs on the breasts will usually improve circulation and healing. If not spayed as a treatment, spaying after resolution is highly recommended.

AGALACTIA is a failure to produce adequate milk. It is most probably a hormonal condition, but may relate to poor glandular envelopment, or poor nutrition. Oxytocin nasal spray and improvement of nutrition may help but many times kittens will have to be nursed by hand.

GALACTORRHEA is excess or unexpected milk production that relates to some type of hormonal imbalance. Hot compresses and hormonal therapy will help this resolve in a few days.

GALACTOSTASIS is milk accumulation in the mammary glands that may occur after weaning, if kittens are not nursing well or associated with mastitis. Milking the glands, treatment of any infection, removal of plugged debris from the nipples and the use of diuretics and cortisone type drugs are usually helpful.

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