Obstetric outcomes in women with vulvodynia and vaginismus: a systematic review

Purpose: Vulvodynia and vaginismus are pain disorders associated with adverse pregnancy outcomes. The few published studies addressing this topic were limited in terms of the different outcomes studied; hence, the purpose of our study was to perform the first systematic review examining maternal, neonatal and obstetric outcomes in patients with vulvodynia and/or vaginismus (VV).

Methods: We conducted a systematic review searching PubMed, EMBASE, Cochrane Library and SCOPUS until November 2023 for observational studies reporting maternal and/or neonatal outcomes of VV in pregnancy. Data on maternal characteristics and obstetric outcomes were independently extracted from the included studies by two reviewers and then summarized between those with and without VV.

Results: The search strategy yielded 1118 citations, of which 10 were included. A total of 2209 patients with a diagnosis of VV prior to pregnancy were identified over a 27-year study period. Compared with women without VV, women with VV were more likely to deliver by cesarean sect. (40.3 vs 29.8%, p < 0.001). Cesarean sections were more likely elective (41.0 vs 35.7%) and performed in response to maternal request (26.0 vs 9.5%) for women with VV. Of those who delivered vaginally, instrumental deliveries were more common among women with VV (16.7 vs 6.2%, p < 0.001), with more perineal injuries as well (43.0 vs 32.7% p < 0.001).

Conclusion: Vaginismus/vulvodynia are high-risk conditions during pregnancy with increased rates of cesarean sections performed for elective reasons and upon maternal request. Offering support, education, and treatment for these conditions prior to pregnancy is important to reduce the rate of avoidable cesarean sections.