⚠️Vaginal buttoning has been included in Vetlexicon Bovis as it is a procedure that is being utilized by veterinarians in some localities. However, the author and editor do not advocate the use of this technique due to animal welfare concerns. 

• Retention of prolapsed vaginal and cervical tissues Cervical/vaginal prolapse.  
• This technique could be considered in situations where the vaginal prolapse is associated with excessive redundancy of the dorsal vaginal wall.

Advantages

• Fast procedure to carry out on farm for experienced veterinary surgeon. 
• Allows cows/heifers to calve with device in place.  
• Tenesmus is rarely seen after button placement (with correct placement).  

Disadvantages

• Outlined under Technical problems and Complications. 

• Bladder entrapment; common in Grade 2-4 vaginal prolapses.
• Risk of perforating the rectum during button placement.
• Risk of internal iliac artery laceration during button placement.

If button placement is too far caudal, a partial eversion of vaginal tissue may occur which could lead to straining and subsequent re-prolapse of the vaginal and cervical tissues.

⚠️The veterinary surgeon performing vaginal prolapse replacement and retention has a responsibility to do so in a way that ensures optimal animal welfare and minimizes the risk of complications. The veterinary surgeon should review all alternative techniques and determine which technique is appropriate for the presenting patient, as all techniques can impact on the patient’s welfare, some more than others. In some cases of chronic prolapse, euthanasia may be the most suitable treatment.

⚠️A specific concern of this technique is the limitations of providing analgesia to the exit route of the application pin. Pre-emptive local analgesia to the region may be inaccurate as to the correct site and depth required. A high-volume epidural would provide analgesia but would result in a recumbent patient. There are also concerns that the pressures put on the device during the birthing process will cause unacceptable additional discomfort to the cow during labor and delivery.

Short term options

• Bühner method Bühner suture: method.
• Bootlace technique.
• Horizontal mattress suture (Halstead) technique.
• Deep vertical mattress suture technique.
• Euthanasia Euthanasia: techniques.

Longer term options

• Caslick procedure Caslick operation.
• Minchev suture.
• Vaginoplasty/vaginal tissue resection.
• Cervicopexy Cervicopexy (transvaginal).

Preparation

• 5-10 min.

Procedure

• 5-10 min.

Criteria for choosing test/procedure

• Candidate selection is important as unsuitable selection can lead to animal welfare issues (unintended pain and injury).
• Unsuitable candidates: severely traumatized and/or infected, and/or desiccated prolapsed tissues, animals that have had previous button placement, animals that experience severe tenesmus despite appropriate anesthesia.
• Assessment of viability of the everted vaginal and cervical tissue before attempting reduction.
• Euthanasia of the animal may be indicated if the vaginal and cervical tissues are severely desiccated, infected, and necrotic.
• Attempts should be made to check for the presence of the urinary bladder in Grade 2 to Grade 4b vaginal/cervical eversions.

Risk assessment

• Ensure the cow is restrained adequately before attempting procedure Restraint techniques.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Beggs D (2012) How I treat….vaginal prolapses. Aust Cattle Vet 8-12 AVA (pdf download).
• Norman S T (2012) Vaginal prolapse. Aust Cattle Vet 63, 20 AVA (pdf download).
• Miesner M D & Anderson D E (2008) Management of uterine and vaginal prolapse in the bovine. Vet Clin Food Anim Pract 24 (2), 409-419 PubMed.

Other sources of information

• Peter A T & King E H (2021) Management of Vaginal, Cervico‐Vaginal, and Uterine Prolapse. In: Bovine Reproduction. 2nd edn. Ed: Hopper R M. Wiley Blackwell, USA. pp 561-578.
• JorVet (online) J0359 Prolapse Repair Kit Instructions for Use. Jorgensen Laboratories Inc, USA. Website: www.jorvet.com.