Have you ever heard the word 'Perineum'? Maybe from your doctor, or maybe you heard about it during pregnancy. This is actually a very important and very sensitive area of our body, but one that we don't talk about much. So, today we're going to talk about it all very simply and in a friendly way. I'll explain everything in a way that you can understand.
Simply put, what is the perineum?
It's very simple. The small, sensitive area of skin between your genitals and your anus is called the perineum.
- In a woman: the area of skin between the vaginal opening and the anus.
- In a man: the area of skin between the testicles (scrotum) and the anus.
But it's not just the skin. Beneath this skin, the deeper structures, including the muscles, tissues, and nerves at the bottom of our pelvic cavity, also belong to this area called the perineum. To be precise, this is like the foundation of our pelvic floor.
What are the functions of the perineum? Why is it so important?
This small area performs a very important function in our body.
- Sexual stimulation: The skin in this area is full of nerve endings, making this area very important for sexual stimulation and satisfaction.
- Supporting the pelvic organs: The perineum area provides a strong foundation and support for the pelvic floor muscles, which help hold things like your bladder, colon, and reproductive organs in place.
- Control of urination and defecation: Since the muscles and nerves involved in the process of urination and defecation pass through this area, it also helps to properly control those processes.
- Childbirth: This area is very crucial for women, especially during vaginal delivery. This area stretches a lot when the baby is born.
Where is this perineum area located?
As we mentioned earlier, this is located between the genitals and the anus. However, if you look inside the body, its boundaries are a little different. Anatomically, this is an area that takes the shape of a diamond.
- Anteriorly: It begins at the pubic symphysis, where the two pelvic bones meet in front.
- Back: Extends to the tailbone/coccyx, which is the lowest bone in your back.
- On both sides: The two pelvic bones (sit bones) that press into the floor when you sit extend to the sides.
When these four boundaries come together, they form a diamond shape. If you mentally draw a line through the middle of this diamond, it will divide into two triangles.
1. Urogenital triangle: This is the anterior part. The genitals, urethra, and related muscles are located in this part.
2. Anal triangle: This is the back part. This part contains the anal sphincter, which controls the opening of the anus and the passage of stool.
At the midpoint where these two triangles meet is a tough, fibrous mass of muscle called the perineal body . This is important for supporting the pelvic floor. It is also the area most likely to be damaged during childbirth.
On average, a woman's perineum is about 1.5 inches long. A man's is 2 inches or a little more.
Common conditions and problems affecting the perineum area
The main cause of damage to this area is childbirth. About 85% of mothers who give birth naturally experience some form of tear in the perineum. However, this area can also be damaged for other reasons, regardless of gender.
| Affected party | Status and description |
|---|---|
| Conditions specific to women | Vaginal delivery: The perineum can stretch and tear as the baby comes out of the vagina. Most tears are minor and heal over time. Some deep tears may need stitches. Severe tears can damage the pelvic floor muscles or the anal sphincter. Episiotomy: This is a small cut made by a doctor in the perineum to enlarge the vaginal opening before delivery. Although this was commonly done in the past, it is now only done in extreme cases. |
| Conditions specific to men | Prostatitis: Infection or swelling of the prostate gland can cause pain in the perineum area. Surgery: This area may need to be cut during prostate surgery, tumor removal, etc. |
| Conditions common to both sexes | Pelvic floor dysfunction: Damage to the perineum can cause difficulty urinating and defecating. Cysts or abscesses: Infected cysts can form in this area. They can be red, swollen, and painful. Hemorrhoids: Swelling of the veins in the rectum can cause itching, pain, or bleeding in the perineum area. Pudendal nerve entrapment: Damage or compression of the main nerve that runs through this area (pudendal nerve) can cause severe pain. Injuries and accidents: Activities such as cycling, motorcycling, and horseback riding can cause damage to this area. Fournier's Gangrene: This is a rare but serious bacterial infection. Also known as "flesh-melting disease," it causes the skin of the genitals and perineum to die. People with diabetes are at higher risk. Sexual abuse: Tears in the perineum area can be a sign of sexual abuse. |
What are the symptoms of these problems?
The main symptom of a problem in the perineum is pain . Especially after childbirth, a tear can be so painful that it is impossible to walk or sit.
The most important thing is not to ignore any pain or discomfort in this area. Even if it's something minor, it's important to talk to your doctor about it.
In addition, the following symptoms may also appear:
- Difficulty urinating or defecating.
- Soreness or itching in the perineum area.
- Men have difficulty achieving erections.
- Pain when urinating or having sex.
- A lump, redness, or swelling in the perineum area.
If you have any of these symptoms, definitely see your doctor.
What tests are done to diagnose these conditions?
Your doctor will first do a physical exam. During this time, they will check for any sores, tears, or lumps in the perineum. Sometimes, they may also insert a gloved finger into your rectum to check for anything unusual (a digital rectal exam).
If the problem seems deeper, imaging tests such as these may be recommended:
- CT Scan: Detect damage to structures inside the body.
- MRI scan (MRI): To identify damage to muscles and blood vessels.
- Ultrasound scan: To see damage to blood vessels.
- X-ray using a special dye: To identify damage to the urethra.
What are the treatments for problems in the perineum area?
Treatment depends on the problem you have. If it's a tear that occurred during childbirth, your doctor will decide whether stitches are needed or not, depending on the size. In the meantime, these things can help reduce pain and discomfort.
- Sitz baths and warm compresses: A sitz bath involves sitting in a shallow basin of warm water for 5-10 minutes twice a day. This cleanses the perineum, reduces pain, and helps wounds heal faster.
- Painkillers: You can take painkillers like Paracetamol or Ibuprofen as directed by your doctor. There are also pain-relieving sprays.
- Peri-bottle: This is a small bottle that you can fill with warm water and spray on the perineum after using the toilet. This can be used to gently clean the wound without further irritating it by wiping it with toilet paper.
- Preventing constipation: Straining during bowel movements can increase pain. Therefore, it is very important to eat foods high in fiber (fruits, vegetables) and drink at least 8 glasses of water a day.
- Kegel exercises: These exercises help strengthen the pelvic floor muscles after childbirth. However, you should definitely consult your doctor or a physiotherapist before doing these if you have an injury.
If there is an infection, antibiotics may be given. If there is an abscess, a small incision may be made to drain the pus. Severe hemorrhoids or nerve damage may require surgery.
Can perineal tearing be prevented during childbirth?
Although it is not possible to prevent a tear 100% of the time, there is a way to reduce the likelihood of it occurring and reduce the severity of the tear. That is perineal massage .
When should this massage start?
It's best to start this after about 34 weeks of your pregnancy.
How often do you need to do it?
Doing it 3-4 days a week, for about 5 minutes at a time, is enough.
How do you do this massage properly?
Before doing this, choose a quiet place where you can relax.
1. First, wash your hands thoroughly with soap.
2. With good support for your back, bend your legs and spread them wide.
3. Apply a natural oil (coconut oil, olive oil) or a water-based lubricant recommended by a doctor to your fingers and perineum area.
4. Gently insert your thumb about an inch or an inch and a half into the vagina.
5. Now gently press your finger against the back wall of the vagina, that is, towards the anus. Press until you feel a slight stretch.
6. Hold this position for a minute or two.
7. Then, very slowly, move your thumb from side to side in a 'U' shape. You should feel a gentle pull.
This may feel a little awkward at first, but it will get easier as you get used to it. You can also talk to your doctor about this and get more advice.
Take-Home Message
- The perineum is a very important, sensitive area located between your genitals and anus.
- This supports the pelvic organs and is also important for urination, defecation, and sexual function.
- It is common for women to experience damage (tears) to this area during childbirth. These often heal spontaneously or with stitches.
- Perineal massage during the final weeks of pregnancy can help minimize damage during childbirth.
- If you experience any pain, swelling, itching, lumps, or other abnormalities in your perineum area, do not ignore it and see your doctor immediately.
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