Vaginismus as an independent risk factor for cesarean delivery

Objective. The present study was aimed to investigate pregnancy outcome of patients with vaginismus, and specifically the relationship between vaginismus and cesarean delivery. Methods. A population based study comparing all pregnancies in patients with and without vaginismus was conducted. Patients lacking prenatal care were excluded from the analysis. Deliveries occurred during the years 1988-2007. A multivariate logistic regression model, with backward elimination, was constructed to find independent risk factors associated with vaginismus. Results. During the study period there were 192,954 deliveries, of which 118 occurred in patients with vaginismus. Patients with vaginismus tended to be younger (26.04+/-4.89 vs. 28.61+/-5.83; p<0.001) and delivered smaller children (3024.2+/-517 g vs. 3160.9+/-576 g; p=0.01) when compared with patients without vaginismus. Patients with vaginismus had higher rates of infertility treatments (5.9% vs. 2.7%, odds ratio [OR] 2.3; 95% confidence interval [CI] 1.1-4.9; p=0.04) and labor induction (37.3% vs. 27.4%, OR 1.6; 95% CI 1.1-2.3; p=0.02), vacuum extraction (9.3% vs. 2.8%, OR 3.6, 95% CI 1.9-6.7; p<0.001), and cesarean delivery (39.0% vs. 14.5%, OR 3.8; 95% CI 2.6-5.5; p<0.001) when compared with the comparison group. Even after controlling for possible confounders associated with cesarean delivery such as previous cesarean delivery, pathological presentations, and fetal distress, vaginismus remained as an independent risk factor for cesarean delivery (OR 7.1; 95% CI 4.5-11.1; p<0.001). Conclusion. Vaginismus is an independent risk factor for cesarean delivery.