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Welcome to the Veterinary Breakroom! In this episode of the breakroom, Beth Molleson, DVM, and Katie Berlin, DVM, share their reactions to WSAVA’s new Guidelines for the Control of Reproduction in Dogs and Cats and the continually evolving conversation about the appropriate timing of spay/neuter, which now includes the suggestion that it might be better for some patients not to be spayed or neutered at all.
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Episode Transcript
This podcast recording represents the opinions of Dr. Katie and Dr. Beth. Content, including the transcript, is presented for discussion purposes and should not be taken as medical advice. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast. The transcript—which was prepared with the assistance of artificial intelligence—is provided as a service to our audience.
Dr. Katie [00:00:10] Hi, I'm Dr. Katie Berlin.
Dr. Beth [00:00:12] And I'm Dr. Beth Molleson.
Dr. Katie [00:00:14] Thanks for joining us in the Veterinary Breakroom. These are short conversations where we talk about relevant topics in that med today, and today we're going to be talking about some new guidelines that were just released by the World Small Animal Veterinary Association or WSAVA, as most of us know it. And these are guidelines about reproductive control. So basically, should we spay and neuter and how often and why or why not? And the guidelines are actually I think they're they're maybe a little bit controversial because the advice in the guidelines can really go fly in the face of what a lot of us learned in vet school and what we've sort of been doing for a long time. So, Beth, do you have any initial impressions about these guidelines that you want to share before we dive in?
Dr. Beth [00:01:06] Yeah, I think you summed it up when you say it does kind of fly in the face of what a lot of us has learned and we'll get into a little bit of the details. But, you know, I think for several years now, there's been a lot more talk about either delayed spay and neutering or lack thereof altogether, which I graduated 13 years ago. And that was just truly not a conversation that we had in that school, at least that I remember. It was just that the standard is at six months we spay and neuter unless there's an outstanding reason. And so I think simply the fact that there is now I wish I remember how many page pages it is, but the fact that there is this very lengthy, lengthy discussion on the current recommendations and the current thoughts and research and evidence based kind of decision making, I think goes to show how much has changed in that time period. One of the leading takeaways from this article that I think may be controversial might might be the right word or surprising, or one that we have to come to terms with and figure out how to implement in our own practice is the fact that female dogs, it is advised and I'm probably going to get the wording wrong. So I encourage everyone to check out the show notes and look at the guidelines for yourself. But I believe the term they used was that no intervention is often the best option for female dogs unless of some other reason. So that, of course, is much different than what I was taught. I was taught to not even wait for the first heat cycle because you're going to increase that risk of mammary cancer. So I think that was my biggest takeaway was kind of that the fact seeing it in writing, you know, I think we have heard a lot of talk about that. We've seen different studies that weigh the pros and cons of both males and females. But to kind of see that as a consensus statement to me was pretty surprising.
Dr. Katie [00:03:03] Yeah, I agree. Like no intervention is just it seems crazy to me. No intervention, meaning like leave the females intact is what that means. And that's pretty crazy. And like you mentioned, we are going to be putting the link to where you can download the guidelines and the executive summary and we'll put that in the show notes. And I definitely would encourage everybody to go and take a look at it because it's a there's a lot of it's really meaty, there's a lot of stuff in there. And so today, rather than focus too much on the medical aspects of it, like we wanted to talk about what the implications are for the conversations we're going to be having in real life in practice. Because as you can imagine, just because it's in a guidelines doesn't mean it's automatically going to change the way people, our clients and our veterinary teams think about about spaying and neutering and the health risks that we've all come to associate with leaving dogs and especially dogs intact. One thing that I really immediately like went on the defensive about reading the summary was thinking about our own safety. Like we're talking so much about health of our patients, which of course is a paramount concern. But I mean, if we're going to be seeing more, well, I should back up and say that the authors do talk about, you know, sterilization as sort of separate from full gonadectomy. So like they'll talk about doing vasectomies in dogs instead of full castration or chemical castration, for instance. And so they are addressing concerns about unwanted breeding by saying, well, there are viable alternatives to taking out the reproductive organs because there are advantages, significant advantages to continuing to have the hormone secreted by reproductive organs. As we know from being women, and we know that menopause is a big deal. And when you take our reproductive hormones away. Our bodies become different. And we you know, things fundamentally change when you remove the ovaries from a mammal body. And so the authors are talking about ways that we can preserve the organs and still try to control unwanted breeding. But I hear that and I think, well, what would life be like if we're seeing intact, large breed male dogs a lot more? And I'm going to sound a little breedist when I say this, but I don't particularly want to see a lot of intact adult male Rottweilers. And this is coming from somebody who has had Rottweilers and loves the breed. But that scares me. And I'm not going to lie. How do you feel about that?
Dr. Beth [00:05:55] Yeah, I think I think you raise an excellent point in the fact that there are a lot of considerations. And I think a lot of what's talked about in this one, like you said, definitely goes back to the fact that we are not just looking at the benefits now of the spay and neutering, but we're looking at the benefits of what these hormones do. So I do think you pointing that out is is perfect. That's kind of the theme of these guidelines, at least when I read it was a lot of discussion on that. Are there sterilization options short of removing the gonads? So I thought that was really interesting. But I think when it comes to we're talking about implementation of this and what it's going to mean for us as practitioners, I think you bring up a really good point that, you know, is it going to be an issue from a maybe behavior standpoint of these intact male dogs? I know that in and of itself is almost a controversial topic because we don't have a lot of great studies on what the influence of hormones is on behavior. I think there's a lot of different thought processes about that. But I know not just our perceptions, but thinking about client perceptions as well. I mean, I can't tell you how many times I get asked, will he calm down once I get him neutered, will he do X, Y or Z once I get him neutered? And so part of my concern with this consensus statement is simply trying to implement it and figure out what it means for us as practitioners. And so many ways it's easier to have a two sentence guideline that says spay or neuter when they're six months old. And now we as the clinicians are tasked with navigating what is best for maybe each individual patient trying to convey the benefits and risks to our clients who may have a lot of preconceived notions of what it means to be intact or to be spayed or neutered. And then another term that I wanted to bring up, too, that's included in this consensus statement is talking about owner responsibility. So I think believe they'll use terms like, you know, for responsible pet owners, meaning those who can ensure that their pet isn't going to mate unwantingly. To me, that's like another burden that I have to carry. Like, what does it mean to be a responsible pet owner? Are we sure that's something we can assess? How do we assess that? Are we, you know, is turning over the power to all of our pet owning population and the general public going to backfire on us in terms of population control or other considerations? So that was one of my other big like caution points was how do we define that and what is how is this going to play out if we do stop spaying and neutering so many of our pets?
Dr. Katie [00:08:49] Yeah, you you made a couple of really good points there. One is, you know, it could be that because we have such limited data as far as how sex hormones really affect behavior, you know, like I don't I don't know how much data there is about that in dogs, but maybe it's a perception issue that I'm more likely to be in danger of seeing intact male mastiffs than I am when I see a neutered male mastiff. Like maybe that's a misperception on my own part. And and that would require some retraining of our brains as people who are raised to think intact large free dogs may be more likely to be aggressive.
Dr. Beth [00:09:32] Well, just to add to that, Katie, is is it a correlation rather than a causation? I mean, I don't want to get into too many stereotypes, but is it that those intact male dogs are maybe owned by people who have encouraged that sort of testosterone fueled behavior that we associate with intact male dogs? I don't know. Maybe that's something we would start to gather more anecdotal data of if we saw more intact dogs.
Dr. Katie [00:09:59] That's a good point. Yeah. Like we can't you know, it is a little bit of a stereotype, but we've all had that. I know if you're listening, you're thinking about a conversation you've had with a certain client who had a certain dog who did not. He did not want to neuter that dog. Like there's definitely a sort of stigma attached to the people who don't who choose not to neuter their dogs in a society where almost every dog is is neutered. So that that's a good point. And you also had brought up, you know, the idea that putting this owner responsibility so squarely in the center here and making us sort of the custodians of decisions around how responsible owners might be, is it feels like a lot of pressure. And I just want to pause for a second and say, you know, these guidelines, it is really important to realize these are guidelines that WSAVA is not trying to go out and say don't stay or neuter anymore. Like they're saying, you know, there are other considerations besides the ones that maybe a lot of us have been trained to think about. And so the conversation is continuing to evolve, as it has since you and I graduated. I mean, when we graduated, like you said, pretty much every dog, you were supposed to spay and neuter them at six months, boom. And since then, we've definitely seen a shift towards waiting, especially in large breed dogs, till they've gone through puberty and even a little after, especially in males but in females as well, despite the fact that we know there's a mammary cancer link, despite the risk of pyometra because we know that there are health benefits to them being able to mature more before they're before they're spayed. So that's already a huge shift and has changed the population significantly, as well as the conversations that I've had in exam rooms. But I also find that a lot of clients still want to just get it done right.
Dr. Beth [00:12:03] Right. And I think that's interesting, too. You know, I think feeling like we have to rightfully kind of consume this information and figure out the best way for us to put all of this knowledge into practice, but then knowing that it's going to be. Probably generations before the general public starts to hear, you know, that that knowledge starts to become more mainstream within the general public. So I do think for a lot of us, we are still spaying and neutering at six months old because for various reasons, a lot of which are valid. So I do think it will also be interesting to see how this plays out with our decision making, especially when it does become that conversation between us and pet owners and taking into account not just the science, but our perceptions, their perceptions. And I think it can get really complex. And you also made another really good point that this consensus guideline is kind of for us to consume the information and make the best choice. It's not telling us what to do or especially in cases of shelter situations, things like that. The best practices are still population control and a focus on all of that. But I do, yeah, it will just be interesting to see what the rates do with spays and neuters. I'm really curious to hear how universities are implementing. I'm sure this is a question we could get the answers to, but curious how universities have implemented this. You know what the teachings are right now when you're going through spay and neuter clinic, what the conversations are like, you know, especially now that this universal guideline has been published, I feel like it may really change the direction of new grads, which will, of course, will influence all of us to some degree.
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Dr. Beth [00:14:23] Yeah. You know, the other thing that I was thinking about, Katie, is what about like dog park sort of thing? And I think even so, many responsible pet owners still like to take their dog to dog parks. Like I don't know.
Dr. Katie [00:14:34] Yeah, I mean, yes, I live in Colorado. Like basically the Colorado Denver area residents treat the whole world like a dog park, like they're dogs everywhere. I don't think I've ever been to a restaurant here that didn't have like dogs sitting outside of their owners tables because it's sunny all year round. You just bring your dog to dinner, you know? Right. And I shudder to think about about going to dog parks if, if because you don't know like which people are or have gotten their dog for vasectimized you know like if it's like if it's got testicles I I'm in the habit of not wanting it at the dog park. And and we're going to see females in heat at the dog park and people are not necessarily going to even have enough information to know whether they're putting their dog in a situation where where unwanted breeding could occur. So it does that does scare me quite a bit. And I'm curious, like if anybody is listening from Europe or for, you know, from a country where spaying and neutering has been a lot less mainstream and just sort of like a blanket recommendation, I'm very curious to know how that is there, because all I really know is the US experience where we're so used to this just being like this is the way it is. Pretty much everyone gets neutered and I'm very, very curious to know how that's panned out. You know, are there dog parks in a lot of other countries? Like do people just take their intact dogs out places with them and it's like, fine, maybe we're maybe we're catastrophizing, you know?
Dr. Beth [00:16:15] But also, I would argue in those communities that general public perception, like we've talked about, has evolved over the decades to maybe include some common sense behaviors when it comes to having an intact male. Whereas I feel like we're starting at baseline. I mean, even as a vet, I'm not sure I would know what to exactly what to recommend to people that want to navigate that situation. As far as, you know, male dog that's maybe intact, wanting to go to a dog, you know, I don't know. There's just a lot of different or wanting to board or things like that, I think. Yeah, yeah. It's it's a lot to think about. I think too part of when I was reading this, one of the things that hit me too, is how much again, there was a big focus on leaving the gonads, but doing other like vasectomies or ovariectomies, which obviously is not leaving the gonads, but different surgical procedures that I'm not well versed in and how that requires extra education and familiarization with those procedures and how that's of course another hurdle for us as bats to try to navigate too.
Dr. Katie [00:17:26] Yes, there's definitely going to be some learning of new things. Like I wouldn't even know the best way to do a vasectomy on a dog. Like I you know, I go in there, take the testicles out. That's what I know. You know and know a couple different ways to do that. But that's the end goal, you know, And I don't do surgery anymore. And I'm kind of relieved, honestly, because I'm thinking about the very large, intact females coming in to get spayed out of necessity when they have a pyometra or some other reason where they're, you know, six years old and maybe kind of chubby and we have to do a procedure then that would have been very simple when they were puppies. And I know we're already seeing that with people allowing now based on more recent recommendations to and research to allow their dogs to mature before spay. And I am not a confident big dog spay person. Like, I just never li that. So I am glad I don't have to do that anymore. But I feel for our colleagues who are going to be seeing a lot more adult dogs. It's going to be harder.
Dr. Beth [00:18:38] Absolutely. And I think that we've kind ofouched on this a lot, but just how being a vet in my mind is so hard, such a hard task. There's so much on our plate. There's so much stress and anxiety, and I love that these recommendations exist. I love that there is a reproduction control committee because I think the more information we have, the better. But I also kind of hate that we're having to juggle one more complex issue throughout our day, and that is what is the best recommendation for each individual pet. I mean, it sounds easy enough, but when you've got ten minutes with a new puppy owner, like, yeah, it's not it's not easy.
Dr. Katie [00:19:23] Yes, it's so true because it's not just one conversation. Like they need to start thinking about this very early. And it used to be that would be an easy like two sentences of, you know, well, when she's this age, we're going to get her scheduled blood work done and get her scheduled for her say, like that was just the way it went. And now this isn't something even that we can we talk a lot about delegating some of these preventive care conversations to our technicians because our credential technicians spend a lot of time with clients, sometimes more than we do, especially in those puppy visits and wellness visits. And they can be such amazing communicators and really talk to clients in detail about these things. But now, you know, more and more it's it's not a one size fits all approach to spay and neuter. And that means more time from us as veterinarians. And I one thing that they did touch on, you know, but because it's an acknowledged risk of leaving an intact female intact longer is they go through heat. They're more likely to get to have mammary tumors develop. And we know this. We've known this for a long time. It's just that now that doesn't cancel out the health benefits in some cases of leaving them intact. But mammary tumors are also tough. Right, BecauseI haven't seen that manyelative to the number of female dogs, because a lot of those dogs were spayed at six months. Because that was the recommendation. And now I'm sure that more and more mammary tumors are going to be getting diagnosed. But it's very difficult to diagnose those tumors with an easy aspirate. You know, you really need a biopsy of of those masses. Are owners going to be willing to do that? Are they going to just accept that conversation of like, you know, she's intact, this could be cancer. We need to take it off and find out. And that's a surgery that then we need to prepare them for later in life because it's very possible that it could happen. So it's a conversation I'm not even used to having.
Dr. Beth [00:21:32] Right. I think what you're saying is that this is going to kind of shift the patient profile of the patient population that we're seeing, which I think, yeah, we'll have a different experience. I think as we as we trend in the direction of less of these babies and neuters for dogs, we will start to experience different pathology, like you said, more frequent mammary tumors. What does that mean? How will that play out? Like you said, I'd be curious to hear in Europe, are they seeing a lot of penetrance? You know, it's it it's an interesting shift, I think. What I would love to see next is. You know, some expert opinions on kind of the takeaways, I guess some an expert middleman telling me what I should take away from this and put into practice is exactly what I need. So, yeah, getting a little bit more education on how to bring this into everyday clinic life, I feel like is the next step from these recommendations.
Dr. Katie [00:22:31] Yes, for sure. And again, these are guidelines. These are not like, okay, this is what we have to do now. Everyone in every case, you know, some cases are going to be cut and dry like best to spay and neuter like we've been doing. But and as you said, as shelter medicine situations are different, you know. But it is interesting to see this. And , you know, we we look at W as as an authority on how we should be practicing. And I think, like you said, this is sort of the latest development in the evolution of how we think about reproduction and control in dogs and cats. And speaking of cats, the guidelines pretty much are like, hey, cats are a pain in the behind when they're intact. You should just keep .
Dr. Katie [00:23:40] So, yeah, nobody wants that. So for the sake of the human animal bond, we should continue to s them.
Dr. Beth [00:23:47] That's right.
Dr. Katie [00:23:49] Well, everybody definitely check out the guidelines again. We'll have the link in the show notes and let us know you have thoughts, especially if this is something, a conversation you've been having for a long time. You know, to the extent that the guidelines are talking about, we'd love to hear about that because this does significantly change the way small animal veterinarians approach preventive care in your average healthy pet. And that's that. I don't think we should understate that. You know, it's a big deal.
Dr. Beth [00:24:20] Absolutely.
Dr. Katie [00:24:22] All right, Beth, let's talk of the week. Do you have one?
Dr. Beth [00:24:26] I do. I have actually have in my world, it's a very big, exciting win. So prepare yourself, Katie. But I got an e-bike yesterday.
Dr. Katie [00:24:40] No, that's really exciting.
Dr. Beth [00:24:41] I say, speaking of things that I think happened probably in Denver. I'm in Ohio. You know, we have a few e-bikes, but I consider myself a trendsetter here. So, yes, I got an e-bike yesterday, came in the mail. I set it up. That process was very exhausting. But I did get out and ride it last night. And the kicker is that I have a basket on the front for Paul. And so we got and we took
Dr. Beth [00:25:11] Yes, I will absolutely send pictures. I wish I could link them in the show notes. But he loved it. He sat in his little basket like he'd been cast as Toto or something. I don't know. He just. We. We. I live right on a bike trail, so we just, like, took that thing as fast as it could go. Up and down. My daughter's school is down the street, so I timed how long it would take to get there on our bike. And it's like two minutes. So I'm really excited. It's a cargo e-bike for anyone else that's into e-bikes. It's a Velo track. It will fit two kids on the back. So it's basically my new minivan. I will I can go to the grocery store on the bike trail, so I'm very excited.
Dr. Katie [00:25:52] That's pretty awesome. And I also am very I love that you live right on a bike trail like that is common in Colorado, not as common in other places I've lived.
Dr. Beth [00:26:02] Yes. It's an old railroad track that over the last like five years has been developed into a bike trail. But then it can, you know, because I live pretty close to the city, but it connects to other bike trails in the city. So we're very lucky. But what about you, Katie? Any big wins this week?
Dr. Katie [00:26:17] Does your bike have a name? I just need to know.
Dr. Beth [00:26:20] I haven't even thought of that prospect. But by next episode, I'll have a name for you.
Dr. Beth [00:27:15] Yes, I believe it looked amazing. Speaking of pictures, I wish we could link those because it looked like a bucket list trip. You could tell from the the pictures. So yeah, that's why I'm glad I went first on the one of the week because I knew your a would be hard to top.
Dr. Katie [00:27:30] Yeah I am happy not to be cold and wet though, because it's very cold and wet in Iceland
Dr. Beth [00:27:34] I don't like being cold and wet, so that eases the FOMO a little bit, but. Well, that's good. We're happy to have you back.
Dr. Katie [00:27:42] Yes, me too. Well, thank you all for joining us in the break room. We, again, would love to hear your thoughts about this. This is a pretty meaty topic, so I'm sure it'll be coming up again in future conversations. But check out those guidelines and let us know what you think. Thanks for joining us.
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The Team:
Beth Molleson, DVM - Host
Katie Berlin, DVM - Host
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Disclaimer: This podcast recording represents the opinions of Dr. Katie Berlin and Dr. Beth Molleson. Content is presented for discussion purposes and should not be taken as medical advice. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.