If she's not having UTI issues, then you might be just fine after a heat or two. I wish I had done the episioplasty, however it turns out that doing it during her spay wouldn't have been a good idea. She had complications and keeping her under longer might have been dangerous. She had a serious bleed and then they weren't able to regulate her temperature. So I think for most dogs it could be done at the same time, but it worked out better for Ella that we didn't do it. Does that make sense? Ella also has allergies and she gets irritation on all of her "under" areas, including that flap of skin that covers the vulva. I think without the allergies she would have fewer issues. Anyway, I think you're fine to wait and see how things go. Ella did have a dental. They did it while she was under but before they started the spay surgery. Even though we brush her teeth, she's prone to tartar. I'm glad we had it done.