Ball, M. DVM. 1997. Caslicks Procedure. Mare Care, Veterinary Practice.

https://thehorse.com/14818/caslicks-procedure/

1937 in Volume 27 of Cornell Veterinarian, 1937, Volume 27

The Caslick procedure of surgically closing the upper part of the vulva has been commonly practiced on
broodmares for the past 60 years. The procedure evolved in an effort to treat what E. A. Caslick, DVM,
had observed–the negative effect that air had on a mare’s reproductive system.

“Early in my experience with the treatment of genital infections, I recognized air as a factor,” Caslick
wrote on the matter. “Mares that were placed on treatment (for genital infections) apparently became
worse for a short period of time and then their condition remained quite constant. If these same mares
were allowed a period of rest, an immediate improvement would be observed.”

Caslick suspicioned that the treatment-related introduction of air into the reproductive system was
doing more harm than the specific treatment was doing good.

“The last case of this infection, I (Caslick) encountered was in 1927. At that time, I became firmly
convinced that the admission of air into the vagina by constant treatment was detrimental, so I
discontinued treatment of the mare and closed the dorsal (upper) half of the vulvar opening (the first
“Caslick’s procedure”). In two months, this mare was normal and negative to culturing (for bacteria in
the reproductive tract).”

In a 1937 volume of the Cornell Veterinarian, Caslick, a native of upstate New York and a graduate of
Cornell’s College of Veterinary Medicine, reported his surgical technique and the thought processes that
lead up to the technique’s development. Large parts of that original article will be quoted here as
Caslick’s writings give great insight from a veterinarian who, in addition to mastering the science, also
(and perhaps more importantly) mastered the art of being a veterinarian.

Wind-sucking, or more technically pneumovagina, was generally accepted as a potential problem in all
racing females.

“It has always been common knowledge to the breeders that a mare with an injury to the upper part of
the vulva and rectum was frequently a ‘wind-sucking’ mare and a bad breeder. Most of them were
permanently sterile, but such injuries affected only a small number of mares. It was not realized that the
mare with a normal vulva might become a bad breeder or permanently sterile for the same reason as an
injured mare.”

When air enters the vagina it can bring in dirt, bacteria, and other debris. It is this contamination that
can lead to vaginitis (inflammation of the vagina), cervicitis (inflammation of the cervix), and metritis
(inflammation of the uterus).

The first barrier that protects the uterus from the outside world is the vulva. A defect in the vulva can
allow contamination to enter the vagina. Abnormalities in the vulva can be from either previous trauma
or deviations from normal anatomy. The second protective barrier is the cervix. The cervix is a
circumferential muscular structure and in essence represents the junction between the vagina and
uterus. During the heat period, the cervix is relaxed, allowing sperm to enter the uterus; in non-heat
periods or during pregnancy, the cervix should remain tightly closed, protecting the uterus or developing
fetus. Wind-sucking can lead to chronic inflammatory states in the vagina, cervix, and potentially the
uterus that can reduce fertility. Wind-sucking during pregnancy can lead to abnormalities in the
developing fetus or even abortion.
The causes and predisposing factors of pneumovagina are essentially unchanged since Caslick’s original
report.

“The mare may begin the habit of wind-sucking at any time, and apparently for no reason, but it usually
follows some derangement of the genital tract,” noted Caslick. “Wind-sucking most often follows
injuries to the upper part of the vulva and rectum. Other factors involved are conformation of the vulva,
age, atrophy of the tissues around the external genital tract, and constant relaxation of the vulva.
Certain types of vulvae appear to favor the chances of a mare becoming a wind-sucker; the two most
common being the near- or over-perpendicular and the partial horizontal.”

These two vulvar conformations favor an incompetency of the vulvar lips. The first is reported to occur
more commonly in maiden mares, and the second in older mares which have a sunken perineal region.
In the partial horizontal, it appears as if the rectum has moved forward, pulling the upper part of the
vulva with it; hence a mid-vulvar part that is horizontal. This conformation also can be associated with
mares which are in very poor body condition. The vulvar abnormalities can be a predisposition, but
Caslick pointed out that “wind-sucking may occur in any mare, none are exempt, not even the maiden or
pregnant mare.”

Wind-sucking can be obvious or subtle in mares.

“The most common symptom (sign) of wind-sucking is the gurgling noise or sound produced by the
aspiration of air into the vagina, or its expulsion,” Caslick observed.

Veterinary inspection can detect abnormalities in the lips of the vulva, an abnormal and persistent “state
of relaxation” of the vulva, and/or the presence of air in the vagina as determined by rectal palpation. A
small amount of foamy material in the vagina or the presence of a purulent (pus-containing) discharge
that develops in a mare approximately five days after breeding is often associated with pneumovagina.

The “operation to prevent wind-sucking” as described by Caslick in 1937 went like this: “The vulva is
cleansed; about half the lips and the upper commissure of the vulva are localized with anesthesia (local
application of anesthetic to numb the tissue). The edges of the lips of the vulva are scarified (the skin
and some subcutaneous tissue is removed with something sharp) to the depth of one-half inch. The two
scarified surfaces are brought together and held in position by metal wound clamps or sutures.”

The length of vulva sutured together depends on the individual needs of the mare. Caslick reported that,
“Any time that the mare is found to be sucking air into the vagina, except in the normal-length heat
period, the act should be stopped.” He believed that this simple operation “saved the life of at least 15%
of Thoroughbred broodmares.”

The “fresh” edges of the vulvar lips heal together quite well and stay that way after suture removal in six
to 10 days. The only remaining fact to point out is an obvious one: Now that the vulvar lips are closed,
they will need to be opened before foaling and potentially before breeding if a substantial length of
vulva was sutured; an episiotomy is performed when foaling is eminent and generally surgically closed
within two to three days post-foaling unless there are complications.