Perineum

Overview

What is the perineum?

Your perineum is the tiny patch of sensitive skin between your genitals (vaginal opening or scrotum) and anus, and it’s also the bottom region of your pelvic cavity. The perineum may refer to just the part of your body you can see (the skin in between your genitals and your anus). Perineum may also refer to the underlying structures inside your body beneath your pelvic floor.

View of the vulva that shows the location of the perineum, situated between the vaginal opening and anus
The perineum is the small patch of flesh located between your vaginal opening and anus.

View of the perineum, surrounded by muscles in the pelvic floor
The perineum is the small patch of flesh located between your penis and anus.

Function

What is the function of the perineum?

Your perineum is an erogenous zone. The skin covering your perineum contains multiple nerve endings that help with sexual arousal and response.

Inside your body, your perineum contains structures that help you pee, poop and have intercourse. If you’re a woman or assigned female at birth (AFAB), your perineum contains structures that help you give birth vaginally. Your perineum forms a foundation that helps support your pelvic floor muscles, which hold organs like your bladder, colon and reproductive organs in place.

Anatomy

Where is the perineum located?

Your perineum is between your genitals and your anus. This part of your perineum that you can see corresponds with structures inside your body that you can’t see. Internally, your perineum is located below the primary muscle of your pelvic floor (levator ani), and it stretches across your pelvic bones.

  • Pubic symphysis joint (front): Your perineum begins at your pubic symphysis, the joint in the front of your pelvis that connects your left and right pelvic bones.
  • Tailbone (back): Your perineum reaches from your pubic symphysis joint back to your tailbone (coccyx).
  • Sitz bones (sides): Your perineum extends onto your sitz bones (or ischial tuberosities) on the right and left sides of your pelvis.

What is the perineum’s structure?

Diagrams sometimes show the perineum’s boundaries as diamond-shaped, with an imaginary line drawn from one sitz bone in your pelvis to the other. This imaginary line divides the diamond into two triangle-shaped regions: the urogenital triangle and the anal triangle.

  • Urogenital triangle: Contains the genitals, the urethra (the tube that moves pee outside your body) and the associated muscles.
  • Anal triangle: Contains the opening of the anus and your anal sphincter (the muscle that helps your anus squeeze and relax so that you can poop).

A tough mass of fibromuscular tissue called the perineal body is located where your urogenital and anal triangles meet. It plays a significant role in supporting your pelvic floor and injures easily during childbirth.

How big is the perineum?

The average perineum is about 1.5 inches (in) long if you’re AFAB (cisgender women, transgender men and nonbinary people with vaginas). It’s about 2 inches or more if you’re assigned male at birth, or AMAB (cisgender men, transgender women and nonbinary people with penises).

What is the perineum made of?

Underneath your perineum’s skin are multiple layers of connective tissue, fatty tissue, muscles and membranes. An important nerve called the pudendal nerve runs through your perineum and branches out into various parts of your anatomy, including your genitals, pelvic floor muscles and anus. This complex nerve network makes your perineum sensitive to sexual sensations and helps you pee and poop.

Conditions and Disorders

What are the common conditions and disorders that affect your perineum?

Childbirth is the most common cause of injury to your perineum. About 85% of people who give birth vaginally experience a torn perineum. Still, you can injure your perineum regardless of your sex.

People with vaginas

  • Vaginal delivery: A baby making their way through your vagina (birth canal) can cause your vagina and your perineum to stretch and tear. Most tears are minor and heal in time. Depending on the tear, you may need stitches to repair the tissue. Major tears can damage your nearby pelvic floor muscles or anal sphincter. A torn perineum can make it difficult to pee, poop or have intercourse.
  • Episiotomy: During this procedure, your provider cuts your perineum before delivery to make your vagina wider for childbirth. Episiotomies were once routine. They’re becoming rarer as increasing evidence suggests that episiotomies may increase the likelihood of pelvic pain and incontinence following delivery for some people.

People with penises

  • Prostatitis (prostate inflammation): An infection or injury affecting your prostate can cause inflammation and pain that you feel in your genitals and perineum.
  • Surgery: Your provider may have to cut your perineum to perform surgery on your prostate, to remove a tumor or to repair a urethral stricture (when the tube that carries pee out of your body is too narrow).

All sexes

  • Pelvic floor dysfunction: Injury to your perineum increases the likelihood you’ll have trouble peeing or pooping.
  • Perineal cysts or abscesses: You can get infected cysts or abscesses on your perineum or inside your anus. They’re often red, swollen and painful.
  • Hemorrhoids: Hemorrhoids are swollen veins in your rectum or anus. They may be inside your body, or they may poke out of your anus. They may cause bleeding, itching or pain in your perineum. That pain may radiate to your rectum and get worse when you’re pooping or immediately afterward.
  • Pudendal nerve entrapment: The pudendal nerve runs through your perineum. If it gets injured and inflamed, you may feel pain in your perineum that starts suddenly or gradually appears over several weeks or even months.
  • Referred pain: A variety of conditions that begin in one part of your body can radiate pain to your perineum. Appendicitis, colitis and some gastrointestinal disorders can cause pain in your perineum.
  • Fournier’s Gangrene: This is a rare bacterial infection and flesh-eating disease that causes the skin of your genitals and your perineum to die. It’s more common in people with penises who are in their 50s and 60s and have diabetes.
  • Injury or trauma: Injuries related to motorcycling, bike riding or horseback riding can damage your perineum. If you’re a cyclist, using a noseless bicycle seat can remove pressure from your perineum and reduce your risk of injury.
  • Sexual abuse: A torn perineum may be a sign of sexual abuse or gender-based violence.

What are common signs or symptoms of a condition involving your perineum?

Pain is the most common sign that something’s wrong with your perineum. After childbirth, you may experience pain from a torn perineum that makes it difficult to walk or sit.

Other symptoms may signal an issue with your perineum or a condition affecting the surrounding muscles or organs in your pelvic cavity, including:

  • Trouble peeing or pooping.
  • Sore or itchy perineum.
  • Difficulty getting an erection.
  • Pain when you pee or have intercourse.
  • A lump on your perineum, redness and swelling.

What are common tests to check the health of your perineum?

Your provider can check for an injury, infection or other condition that’s affecting your perineum by doing a physical exam. The exam may include a digital rectal exam, where your provider places a gloved finger into your rectum to feel for any irregularities.

Imaging procedures can help your provider diagnose problems affecting your perineum:

  • CT Scan: Can show if there’s been an internal injury to your perineum.
  • MRI: Can show if there’s been damage to the blood vessels or muscles in your perineum.
  • Ultrasound: Can show damaged blood vessels in your perineum.
  • X-Ray with dye: Can show any damage to your urethra (the tube that carries pee out of your body). Your urethra passes through tissue in your perineum.

What are common treatments for the perineum?

Your provider can assess any cuts or tears on your perineum to determine whether you need stitches to repair your injury. In the meantime, pain management strategies can ease your symptoms as you heal.

  • Sitz bath and warm compresses: A sitz bath is a shallow, warm-water bath that cleans your perineum and aids in healing. You should use a sitz bath twice a day for at least five to ten minutes. Pat your perineum dry after leaving the bath instead of scrubbing.
  • Pain medications and numbing sprays: Taking acetaminophen (Tylenol®) or ibuprofen (Advil®) and using pain-numbing sprays can ease the pain while your body heals. Hemorrhoid wipes and creams can help with pain, itching or burning in your perineum, too.
  • Peri-bottle: A peri-bottle is a small container that you can fill with warm water and use to spray your perineum after going to the bathroom. It cleans you gently so that you don’t have to wipe with toilet paper.
  • Constipation prevention: Straining through bowel movements may worsen perineum pain. Eating a high-fiber diet and drinking at least eight cups of water a day can help prevent constipation.
  • Pelvic floor exercises (Kegel exercises): Strengthening your pelvic floor muscles after childbirth can help your body heal and rebuild after experiencing tears. Your healthcare provider may refer you to a physical therapist for specialized pelvic floor exercises. Only attempt Kegels following an injury with your provider’s guidance.

Your provider may prescribe antibiotics or incise (cut) and drain an infected cyst. You may need surgery if you have severe hemorrhoids or nerve damage in your perineum.

Care

Does massaging your perineum prevent tears during childbirth?

You can’t prevent your perineum from tearing, but massaging it before childbirth and during delivery reduces the likelihood that it will tear.

When should you start massaging your perineum?

Begin massaging your perineum around week 34 of your pregnancy.

How often should I massage my perineum?

Set aside massage sessions that last for five minutes. Plan to massage your perineum three to four times a week.

How do you massage your perineum?

Carve out a time and space for massaging your perineum that allows you to feel as relaxed as possible. Before you begin, wash your hands with a mild soap to prevent bacteria from entering your vagina.

  1. Lie on your back with your legs wide and knees bent, making sure that your back is supported the entire time.
  2. Apply a natural oil (coconut oil, olive oil) or a water-soluble lubricant (Astroglide®, K-Y Jelly®) to your fingers, thumbs and your perineum.
  3. Place a single, lubricated thumb about 1 to 1.5 inches into your vagina. Gently insert your other thumb.
  4. Press both thumbs on the back wall of your vagina toward your anus, applying enough pressure to feel slight stretching within your vagina. Hold this position for a minute or two.
  5. Move both thumbs slowly in a U-like motion so that you feel a gentle stretch.

A note from Cleveland Clinic

Your perineum includes the delicate portion of skin between your genitals and anus and the underlying tissues that make up the bottom part of your pelvic cavity. It plays an important role in the structural integrity of your pelvis. That said, don’t be alarmed if your perineum tears during childbirth. Your tear may require stitches, but most injuries heal in time. Your healthcare provider can recommend pain management strategies that ease your symptoms as you heal.

Last reviewed by a Cleveland Clinic medical professional on 10/26/2022.

References

  • Aquino CI, Guida M, Saccone G, et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. (https://pubmed.ncbi.nlm.nih.gov/30107756/) J Matern Fetal Neonatal Med. 2020;33(6):1051-1063. Accessed 10/26/2022.
  • Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. (https://pubmed.ncbi.nlm.nih.gov/23633325/) Cochrane Database Syst Rev. 2013;(4):CD005123. Published 2013 Apr 30. Accessed 10/26/2022.
  • Bols EM, Hendriks EJ, Berghmans BC, Baeten CG, Nijhuis JG, de Bie RA. A systematic review of etiological factors for postpartum fecal incontinence. (https://pubmed.ncbi.nlm.nih.gov/20199348/) Acta Obstet Gynecol Scand. 2010;89(3):302-314. Accessed 10/26/2022.
  • Goh R, Goh D, Ellepola H. Perineal tears - A review. (https://pubmed.ncbi.nlm.nih.gov/29429318/) Aust J Gen Pract. 2018;47(1-2):35-38. Accessed 10/26/2022.
  • Shmueli A, Gabbay Benziv R, Hiersch L, et al. Episiotomy - risk factors and outcomes. (https://pubmed.ncbi.nlm.nih.gov/27018243/) J Matern Fetal Neonatal Med. 2017;30(3):251-256. Accessed 10/26/2022.

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