Vaginismus and pregnancy outcomes

OBJECTIVE: Women with vaginismus experience difficulties in allowing penetration of any object into the vagina. The objective of this study was to determine if vaginismus is a risk factor for surgical intervention during labor. STUDY DESIGN: This was a retrospective case-control study, based on women delivering at the Ziv Medical Center between 2013 and 2017, in which we examined the difference in the rate of interventions during labor in primiparous women with vaginismus, either self-reported or diagnosed by the admitting clinician. This group was compared to a matched control group. Also examined was the incidence of perineal lacerations or episiotomies, especially requiring suturing under general anesthesia. RESULTS: The study included a total of 78 primiparous women ≥37.0 weeks’ gestation who gave birth to their first child at Ziv Medical Center: 26 women with vaginismus and 52 women in a control group that were similar with regards to age, gestational age, BMI, and birthweight. The rate of cesarean section was higher in patients with vaginismus: 38.4% in the vaginismus group and 11.5% in the control group (OR 5.6). Patient request for cesarean section, which after counseling is respected at our institution, was significantly higher in the group with vaginismus (54.5% vs. 0% in the control group, OR 15.3). Additionally, more women with vaginismus delivering vaginally with a perineal laceration or episiotomy required general anesthesia to enable suturing (26.7% vs. 0%, OR 36.4) due to extreme discomfort despite local anesthesia. CONCLUSION: Vaginismus risk is a significant risk factor for cesarean section. Also, if these women deliver vaginally, they more often require general anesthesia for perineal repair.