What is the perineum? Let's learn about this small but very important part of your body.

Hello! How are you? Today we are going to talk about a part of our body that we probably don't talk about much, but is very important. This is what doctors call the perineum. You may not have heard this name before. But don't worry, we will talk about it very simply, in a way that you can understand.

What exactly is the perineum? Where is it located?

Simply put, your perineum is the sensitive strip of skin between your genitals (the opening of your vagina in women, or your scrotum in men) and your anus (where we poop). Think of it like a small space. This is the part that we see outside.

But, the perineum is not just the skin that is visible on the outside. It is actually the area that lies beneath our pelvic cavity. That is, beneath that skin, some important structures and muscles inside our body belong to it. To be precise, it is located beneath the muscles of our pelvic floor.

So, you see, right? This may seem like a small place, but it's actually something much deeper than that.

What happens to the perineum? Why is this important to us?

This little perineum helps with a lot more than you think.

• For sexual stimulation and pleasure: The perineum has many nerve endings in the skin. These help with sexual stimulation and response. This means that this is an erogenous zone of our body.
• Pelvic floor support: The muscles in our pelvic floor are what hold things like our bladder, part of our colon, and reproductive organs in place. The perineum provides a good foundation and support for these pelvic floor muscles.
• Urination, defecation, and sexual intercourse: Inside our bodies, the structures in the perineum help with these processes.
• Childbirth (for women): The structures in a woman's perineum help her deliver a baby vaginally. This area is the area that stretches the most during childbirth.

Now you understand the importance of this, right?

Let's learn a little more about the location and shape of the perineum.

We said that the perineum is located between the genitals and the anus. This visible part corresponds to the structures inside the body that we cannot see.

Internally, the perineum is located beneath the main muscle of our pelvic floor (levator ani muscle). It also extends across our pelvic bones. Think of it this way:

• Anteriorly: The perineum begins at the pubic symphysis, the joint between the left and right pelvic bones, in the front of our pelvis.
• Behind: From there, it extends all the way to the tailbone/coccyx.
• Laterally: This extends to the two bones (sitz bones or ischial tuberosities) on the right and left sides of our pelvis, which press into the ground when we sit.

Doctors sometimes depict the boundaries of the perineum as a diamond shape. Imagine an imaginary line drawn between your two sit bones. This line divides the diamond into two triangles:

1. Urogenital triangle: This is where the genitals, urethra, and associated muscles are located.

2. Anal triangle: This is where the anal opening and the anal sphincter muscles are located. These muscles help to tighten and relax the anus during bowel movements.

Where these two triangles meet, there is a thick mass of fibrous-muscular tissue called the perineal body . This plays a major role in supporting the pelvic floor. This area is more susceptible to injury during childbirth.

How big is the perineum? What is it made of?

A woman's perineum is usually about 1.5 inches (3.8 centimeters) long. A man's perineum can be 2 inches (5 centimeters) or a little longer.

The perineum has several layers beneath the skin. These include connective tissue, fatty tissue, muscle, and membranes . A very important nerve called the pudendal nerve runs through the perineum, branching out to areas such as our genitals, pelvic floor muscles, and rectum. This complex network of nerves is what allows the perineum to respond to sexual sensations and to help us urinate and defecate.

What are the common conditions and diseases that affect the perineum?

The main cause of perineal injury is childbirth . About 85% of mothers who give birth vaginally suffer a perineal tear. However, anyone, regardless of gender, can suffer a perineal injury.

Things that especially affect women

• Vaginal delivery: As the baby comes out of the vagina, the vagina and perineum stretch, sometimes tearing. Most of the time, these are small tears that heal over time. However, depending on the size of the tear, stitches may be needed to repair the tissue. Larger tears can damage the nearby pelvic floor muscles or anal muscles. When the perineum is torn, it can be difficult to urinate, defecate, or have sex.
• Episiotomy: This is when a doctor or midwife makes a small cut in the perineum before delivery to widen the vaginal opening. This used to be common, but is no longer done. Some studies have shown that some women who have an episiotomy may experience pelvic pain and incontinence later in life.

Things that specifically affect men

• Prostatitis: If the prostate gland becomes infected or injured, it can become swollen and painful. This pain can be felt in the genitals and perineum.
• Surgery: Sometimes doctors have to cut the perineum to perform prostate surgery, remove a tumor, or treat a urethral stricture.

Things that affect both sexes

The following conditions can occur in both women and men:

• Pelvic floor dysfunction: If the perineum is damaged, there is a greater chance of difficulty urinating or defecating.
• Perineal cysts or abscesses: Infected cysts can form on the skin of the perineum or inside the anus. These are often red, swollen, and painful.
• Hemorrhoids: These are swollen veins in or around the anus. They can be internal or external. They can cause bleeding, itching, or pain in the perineum.
• Pudendal nerve entrapment: The pudendal nerve, which we discussed earlier, runs through the perineum. If it becomes injured and inflamed, it can cause pain in the perineum. This pain can start suddenly or gradually increase over several weeks or months.
• Referred pain: Some conditions that start in one part of the body can cause pain in the perineum. For example , appendicitis, colitis , and some gastrointestinal diseases can cause pain in the perineum.
• Fournier's Gangrene: This is a very rare, bacterial infection that causes the skin of the genitals and perineum to die. It is most common in men between the ages of 50 and 60 who have diabetes.
• Injury or trauma: Accidents such as motorcycle riding, cycling, and horseback riding can damage the perineum. If you are a cyclist, using a noseless bicycle seat can reduce the pressure on the perineum and reduce the risk of injury.
• Sexual abuse: A torn or injured perineum can be a sign of sexual abuse or violence.

How do you know if you have a problem with the perineum? (Symptoms)

The main sign that something is wrong with the perineum is pain . After childbirth, the pain that comes with tearing the perineum can make it difficult to walk or sit.

There may be other symptoms, which may indicate a problem with the muscles and organs in the perineum or surrounding pelvic cavity:

• Difficulty urinating or defecating.
• The perineum is sore or itchy.
• Pain during sex or urination.
• Men have difficulty getting an erection.
• A lump, redness, or swelling in the perineum.

If you have symptoms like these, it's best to see a doctor and seek advice without being embarrassed or afraid.

Tests to check the health of the perineum

Your doctor can perform a physical exam to check for any injuries, infections, or other conditions in the perineum. This exam may also include a digital rectal exam, which can detect any abnormalities.

In addition, imaging procedures can also identify problems in the perineum:

• CT Scan: Can check for damage to the perineum inside the body.
• MRI: Shows whether there is damage to the blood vessels or muscles in the perineum.
• Ultrasound: Shows damaged blood vessels in the perineum.
• X-Ray with dye: This can be used to see if there is any damage to the urethra, as the urethra passes through the tissue of the perineum.

What are the treatments for the perineum?

If you have a cut or tear in your perineum, your doctor will decide if it needs stitches to heal. In the meantime, you can do these things to help reduce pain:

• Sitz baths and warm compresses: Sitz baths are a method of soaking the perineum in shallow, lukewarm water to help cleanse and heal it. Do this for five to ten minutes twice a day. After bathing, gently pat the perineum dry rather than vigorously.
• Painkillers and numbing sprays: Taking painkillers like Paracetamol or Ibuprofen , or using pain-relieving sprays, can help control the pain until it heals. If you have hemorrhoids, wipes and creams can also help reduce pain, itching, and inflammation in the perineum.
• Peri-bottle: This is a small bottle that you can fill with warm water and use to wash your perineum after using the toilet. This will reduce the risk of injury from wiping with toilet paper.
• Preventing constipation: Straining during bowel movements can increase perineal pain. Constipation can be prevented by eating foods high in fiber (vegetables, fruits, and legumes) and drinking at least eight glasses of water a day.
• Pelvic floor exercises: Doing Kegel exercises after childbirth can help strengthen your pelvic floor muscles and help your body recover from things like sprains and strains. Your doctor may refer you to a physical therapist for specific pelvic floor exercises. But remember, these exercises should only be done under medical supervision after an injury.

If there is an infected lump, the doctor may prescribe antibiotics , or they may incise and drain it. Surgery may also be necessary if there is severe hemorrhoids or nerve damage in the perineum.

Does massage help reduce tearing of the perineum during childbirth?

It is not possible to completely prevent perineal tears, but it is said that massaging the perineum before and during labor can reduce the likelihood of tearing.

When should I start this massage? How often should I do it?

It's a good idea to start this perineum massage around 34 weeks into your pregnancy.

Set aside about five minutes at a time. Plan to do this massage three to four times a week.

How to massage the perineum?

Before doing this, choose a time and place where you can relax. Before you begin, wash your hands thoroughly with a mild soap. This will help prevent bacteria from entering the vagina.

• Lie on your back, spread your legs wide, and bend your knees. Make sure your back is well supported.
• Apply a little natural oil (like coconut oil, olive oil) or a water-soluble lubricant to your fingers, thumb, and perineum.
• Insert one of your thumbs (with some lubrication) about an inch or an inch and a half into your vagina. Then slowly insert your other thumb.
• Press the back wall of the vagina towards the anus with both thumbs. Apply enough pressure to feel a slight pull inside the vagina. Hold this position for a minute or two.
• Then slowly move your thumbs in a "U" shape. You will feel a gentle pull.

If you feel any pain while doing this, stop. Also, it's a good idea to talk to your doctor about this.

Things we need to remember

Your perineum is the delicate area of ​​skin between your genitals and anus, and the underlying tissue that forms the floor of your pelvic cavity. It is very important for the structural stability of your pelvis.

However, don't panic if your perineum tears during childbirth. You may need stitches, but most injuries heal over time. Your doctor will advise you on ways to manage the pain while you recover. It's important to be aware of this part of your body and to seek medical advice immediately if you have any concerns. Stay healthy!

` Perineum, pelvic health, childbirth, perineal tear, perineal massage, women's health, men's health