Who needs the “fixing”?

Are gonadectomies absolutely necessary?

Surgical sterilization has ever been uniquely under the purview of veterinarians. It’s served our profession as a direct source of income, a client attraction tool, a driver of wellness services, and, in recent decades, a moral platform. Spaying and neutering pets promotes veterinary legitimacy and a reputation for virtuosity. It’s from this high ground that we may collectively rail against overpopulation, reproductive disease, and other inhumanities.

Given the financial and reputational benefits surgical sterilization offers the veterinary profession, it’s no wonder that “fix your pets” has long been the veterinarian’s mantra. Indeed, the drive to sterilize has served us well as one of our profession’s best-loved and rarely contradicted institutional pillars. Lately, however, this foundation is showing signs of wear.

Not set in stone

The ideal timing of canine sterilization is under increasing scrutiny. Uncertainty and dispute over when (or even whether) gonadectomy is indicated has fissured the edifice of our once-monolithic American worldview on canine sterilization, one which exhorts that we always gonadectomize pre- or peripuberally, with exceptions only for responsibly designated breeding animals.

This scrutiny, coupled with an increasingly individualized approach to companion animal medicine, has birthed a neo-natal but vocal movement of veterinarians and pet owners who have parted with the establishment on this issue. If we demand the most targeted and specialized approach to health care when it comes to accident or illness, why wouldn’t we do the same when it comes to reproductive services like sterilization?

Are gonadectomies absolutely necessary, we ask? Are some dogs better off keeping their testicles and ovaries for a time? For life? What do we really know about the long-term effects of gonadectomy in dogs? When might the benefits of intact gonads outweigh their well-researched risks?

To be sure, the benefits of gonadectomy have been quantified and promoted for decades. Its risks, however, have been largely disregarded, even disdained, within the profession. Any potential benefits of gonadectomy postponement are widely assumed to be statistical blips or questionably researched. For those predisposed to a one-size-fits-all approach to sterilization, these arguments against early gonadectomy are readily discarded.

The strength of this prevailing attitude means veterinarians who take gonadectomy research seriously, incorporate its findings into their practices, and urge others to keep an open mind (as I have) are targets for vituperative pro-gonadectomy commentary. Here are some milder examples of the comments
I received when last I raised this issue in this column:

  • “You’ve clearly never worked in a shelter and witnessed firsthand the effects of overpopulation.” (I have. It sucks. I still spay and neuter every day.)
  • “You’re violating your veterinarian’s oath by promoting morbidity and mortality via reproductive disease.” (Gonadectomy has risks, too. Intact patients receive rewards, as well.)
  • “You’re humanizing dogs.” (Not any more than we do when we recommend specialized medical and surgical treatment for illness and injury. Why does reproduction not qualify as a category of critical medical decision-making?)

These traditionalists question our loyalty both to animals and to our profession, often conflating our attitudes toward individual dogs with those we might hold for canine shelter populations and for cats. They even go as far as to question whether I’m taking a machista point of view, especially on retaining male gonads (since I’m Hispanic). “Perhaps your culture has poisoned your thinking?”

As one of the very few veterinarians willing to vasectomize and perform tubal ligations when sterilization is required (either by law or for pregnancy prevention), I’m considered by many of you to be one of those creepy people who caters to the crazies. But you miss the point. This is no anti-science, anti-vaxer, raw-feeding kind of thing that too often relies on wishful thinking. It’s about treating dogs like their gonads matter.

A basis in research?

It’s true this kind of veterinary work attracts those who think outside the box, and yes, they’re often eccentric (to be kind), but they’re also united by a deeply held belief their dog deserves the highest-quality reproductive care, too. Ironically, those who elect these procedures and/or choose to delay gonadectomy for a set period (typically until physical and social maturity) also are among the dog owners least likely to let their dogs irresponsibly consort with others.

I’m also not denying that treating dogs as reproductively unique becomes far more challenging in a shelter environment or among clients who don’t understand how easily their pets can reproduce and the dangers inherent in reproductive behavior (disease, dystocia, etc.). Indeed, as a matter of public policy, I’m decidedly in favor of shelter sterilization. Yet, if a client expects me to offer recommendations for the optimization of their individual dog’s health, it becomes difficult to ignore the emerging research along with the reality of our status quo’s shaky scientific foundation. Why the mindless war against canine gonads?

After all, if you can imagine a world where overpopulation was not a factor, one where dog owners would be horrified if their dogs accidentally mated, one where they’d readily gonadectomize as soon as the risks of reproductive organs outweighed their rewards, would you be so keen to sterilize all pups at six months? Or would you be more likely to start examining the science behind the ideal timing of sterilization so you could help your clients make clear-eyed, customized decisions?

A standard policy?

Enter the New York Times’ Sept. 3 opinion column titled, “Dogs Are Not Here For Our Convenience.” In it, PhD cognitive scientist Alexandra Horowitz, who heads the Horowitz Dog Cognition Lab and teaches at Columbia University, incited her own trollish following when she wrote, “Spaying and neutering puppies shouldn’t be standard policy—and it isn’t automatically the ‘responsible’ choice either.” In this thoughtful piece, she made many of my own arguments, effectively injecting this under-the-radar veterinary debate into the mainstream.

Predictably, the online comment section on this column had to be closed in less than a day. Dog owners were shocked and dismayed to see one of their own subvert the status quo so vociferously. What kind of a dog scientist abandons the spay-neuter paradigm, they demanded to know? Has she lost her reason? Or is she introducing the U.S. to the notion that even our most dearly held beliefs sometimes deserve rethinking.

When it comes to reproductive health, I can’t help thinking perhaps it’s us that needs the “fixing.” As veterinarians, I believe it’s up to our community to more dispassionately examine this issue. It helps us not at all to discount or deplore the science merely because it’s inconvenient to explain or problematic as a matter of public policy.

After all, if we’re expecting our clients to line up for rehabilitation medicine, chemotherapy, and cataract surgery, we should be prepared to treat all our patients as if gonadectomy were the medical decision it is and not the moral imperative that seems, at the moment, to serve our patients and our profession best.

Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.

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