Perineal pain can affect people of both sexes. In males, the perineum sits just behind the scrotum and extends to the anus. In females, the perineum begins at the front of the vulva and extends to the anus.
Pain in the perineum is common in women, who may receive injuries during or after childbirth. It is more likely to last longer following the delivery of a first child.
In this article, we discuss possible causes of perineum pain and how to treat them.
Tears during childbirth
A possible cause of perineum pain is tearing during childbirth.
Most women experience some trauma to the perineum when giving birth to their first child. Some will experience more severe tearing that extends beyond the vagina, deep into either the adjacent muscle or the anus.
Tears can be painful and make it difficult to walk, use the restroom, or perform other daily functions. This pain can last for several weeks.
Tears can affect the muscles beneath the perineum. More severe tears can cause ongoing muscle problems, which can be very painful and may affect the function of the urinary bladder or even that of the anal sphincter. Some women also experience pain during sex.
Regular sitz baths, cold packs, and numbing sprays may help treat the pain. A woman should see a doctor if the tear occurs with signs of infection, such as:
- severe pain
- a bad smell coming from the tear
- oozing from the tear
After the tear heals, some women use pelvic floor physical therapy to manage chronic pain.
An episiotomy is a procedure in which doctors make a small cut into the perineum to expand the vaginal opening during childbirth.
This procedure is still fairly common during childbirth. However, an increasing number of experts are recommending against the use of routine episiotomies, as some research suggests that they might increase the risk of incontinence and pelvic pain.
The pain resulting from an episiotomy is similar to that of a perineal tear. The severity of the symptoms and the healing time will vary among women, depending on the type of tear or episiotomy.
Sitz baths, numbing sprays, and over-the-counter pain relievers can provide short term relief. Pelvic floor physical therapy is useful for managing symptoms in the long term. In some cases, the episiotomy can injure surrounding areas, and it may make surgery necessary.
Other perineal injuries
Pain relieving medication may help treat scratches or cuts on the perineum.
Both males and females can experience other perineal injuries.
Trauma, such as that from a fall or an assault, can damage the muscles or skin of the perineum. Some health conditions, including diabetes, can cause nerve damage in the perineum.
The right home treatment will depend on the injury. Nerve pain will often require treatment from a doctor, but some scratches or cuts will improve with sitz baths and pain relieving medication. Regardless of the cause, it is always best to see a doctor about perineal injuries.
Pelvic floor dysfunction
The pelvic floor muscles sit at the bottom of the pelvis and support pelvic organs, such as the urinary bladder.
Pelvic floor dysfunction can occur when the muscles become too tight, causing pain and tension. Alternatively, the muscles may become too weak, resulting in bladder incontinence. Pelvic floor dysfunction may also affect a person’s ability to pass stool.
Anyone can develop pelvic floor dysfunction, but it is particularly common during or after pregnancy and in people with a history of trauma — for example, from an episiotomy — to the perineum. Many people with pelvic floor dysfunction experience pelvic pain, especially in the perineum.
While pelvic floor exercises are helpful, the right exercises depend on the type of dysfunction. It is important to work with a doctor or physical therapist to determine the most effective exercises.
Referred pain is pain that begins somewhere else in the body and radiates to the perineum. Appendicitis, colitis, and some other gastrointestinal conditions may cause referred pain in the perineum.
Prostatitis and other prostate conditions
Inflammation of the prostate, which is called prostatitis, can cause pain in the perineum. The inflammation can occur suddenly due to an infection or injury, and in some cases, it may be long term.
Warm compresses or sitz baths may help with the pain, but these home remedies will not treat the underlying cause. In cases where a bacterial infection is the cause of prostatitis, a doctor is likely to prescribe a course of antibiotics.
Other prostate issues may cause symptoms similar to those of prostatitis. Therefore, a person should see a doctor if perineal pain occurs during urination or sex.
Infections can cause swelling and pain near the perineum.
An infected cyst or abscess in the anus or elsewhere in the perineum can swell and become very painful. If the area looks red and swollen or there is a painful cyst on the perineum, this may be a sign of infection.
Warm compresses and numbing sprays may help with the pain. It may be necessary to treat certain infections with prescription antibiotics. Some abscesses may require incision and drainage, while it may be necessary to remove an infected cyst surgically.
Hemorrhoids are swollen blood vessels in the anus. Internal hemorrhoids sometimes cause bleeding during bowel movements. External hemorrhoids may bleed, itch, or cause pain.
Some hemorrhoids put pressure on the perineum. This pressure can cause pain in the perineum that may radiate to the rectum. The pain may be worse during, or right after, a bowel movement.
Surgery may be necessary to remove severe hemorrhoids.
In less severe cases, people can use hemorrhoid wipes to soothe the skin and keep the area clean. Using hemorrhoid cream or soaking the area in a sitz bath after each bowel movement can also provide symptom relief. Eating a diet high in fiber and drinking plenty of water can help prevent constipation and straining, which are common causes of enlarged hemorrhoids.
Pudendal nerve entrapment
The pudendal nerve is in the pelvis. It can become inflamed or entrapped, often due to another injury. If this occurs, it tends to cause nerve pain that may involve the perineum. The pain can appear suddenly or develop gradually over many weeks or months.
Massaging the area and taking pain relievers may provide temporary relief. However, people with this condition should see a doctor.
When to see a doctor
A person should talk to their doctor if they experience severe perineal pain.
Some causes of perineal pain, such as minor injuries or tears from childbirth, will go away on their own.
It is important to see a doctor for severe perineal pain. Most cases are treatable with the right care.
In some cases, a doctor may refer someone with perineum pain to a physical therapist for pelvic floor strengthening exercises.
Pain in the perineum can be intense and make routine activities difficult. There are many possible causes of the pain, most of which are easily treatable and do not cause long term damage. It is important not to ignore the pain and to see a doctor for diagnosis and treatment.