Understanding the perineum
The perineum refers to the area between the anus and genitals, extending from either the vaginal opening to the anus or the scrotum to the anus.
This area is near several nerves, muscles, and organs, so it’s not uncommon to feel pain in your perineum. Injuries, urinary tract issues, infections, and other conditions can cause perineum pain.
Read on to learn more about the potential causes and how to identify them.
Causes for all
Several conditions can cause perineum pain in all sexes.
A urinary tract infection (UTI) is an infection in any part of your urinary system, such as your urethra, bladder, ureters, or kidneys. Most UTIs affect the lower urinary tract, which includes your bladder and urethra.
UTIs tend to be more common in women, but anyone can get them. They happen when bacteria enter your body through your urethra, causing an infection.
In addition to perineum pain, UTIs can also cause:
an intense and persistent need to urinate
burning sensation during urination
frequent urination, with only small amounts coming out
cloudy or unusually colored urine
dull pelvic pain in women
Interstitial cystitis is another word for painful bladder syndrome. This is a long-lasting condition that can cause varying levels of pain and pressure in your bladder and pelvis.
Similar to UTIs, interstitial cystitis is more common in women but it can affect all sexes. It’s caused by a malfunction of your pelvic nerves.
Instead of signaling you only when your bladder is full, they signal you throughout the day and night. This can result in perineum pain for some people.
Additional symptoms of interstitial cystitis can include:
chronic pelvic pain
frequent urination, usually with only small amounts coming out
urgent need to urinate
pain when your bladder’s full
pain during sex
Injuries to the perineum are fairly common. Accidents, falls, and blows to the groin can cause bruising, bleeding, and even tears in the perineum. This can lead to throbbing and intense pain, followed by weeks of tenderness.
It can also result in damage to the nerves and blood vessels in the perineum, which can cause bladder issues or problems during sex.
Common causes of perineum injuries include:
falls, such as onto a bike crossbar
gym equipment accident
sexual assault or abuse
gradual damage from frequent activities, such as bike or horseback riding
climbing over a fence or wall
kicks to the groin or other blunt trauma
intense sexual activity
An abscess is a painful pocket of pus that can develop anywhere on or in your body. They happen when bacteria enter your body and cause an infection. Your immune system sends white blood cells to the area, which can cause pus to form in the area.
You can develop an abscess directly on the perineum or on a nearby area, such as the vulva or scrotum. An anal abscess can also cause pain in the perineum. These are usually the result of an infection of your internal anal glands.
Other symptoms of an abscess include:
a red, pimple-like bump on your skin
a bump under your skin
redness and swelling
fever and chills
Pelvic floor dysfunction
Your pelvic floor is the group of muscles that support the organs in your pelvis, including the bladder, rectum, and uterus or prostate. These muscles also play an essential role in your bowel movements.
Pelvic floor dysfunction happens when these muscles don’t contract and relax the way they usually do. Experts aren’t completely sure about why this happens, but it’s likely related to conditions or injuries that weaken your pelvic muscles or cause tears in connective tissue. These can include childbirth and pelvic surgery.
Some people with pelvic floor dysfunction experience perineum pain.
Other potential symptoms of pelvic floor dysfunction include:
frequently feeling like you need to have a bowel movement
feeling like you can’t have a complete bowel movement
chronic pain in your pelvic area, genitals, or rectum
pain in your lower back
vaginal pain during sex
Pudendal nerve entrapment
The pudendal nerve is one of the primary nerves of your pelvis. It travels to your perineum, rectum, lower buttocks, and genitalia. Pudendal nerve entrapment is a type of nerve damage. It happens when surrounding tissue or muscle starts to compress the nerve.
This type of compression may happen after an injury, such as a broken pelvic bone, surgery, or a tumor of some kind. It can also happen after childbirth.
The primary symptom of pudendal nerve entrapment is ongoing pain somewhere in your pelvic region, including your perineum, scrotum, vulva, or rectum.
This type of nerve pain can be:
gradual or sudden
burning, crushing, shooting, or prickling
constant or intermittent
worse when sitting
You might also feel numbness in the area or it may feel like an object, such as a golf ball, is stuck in your perineum.
Causes in males
Prostatitis is condition that involves the swelling and inflammation of your prostate. This is the gland that produces seminal fluid. It’s located just below your bladder and is usually about the size of a golf ball.
Prostatitis has several possible causes, including bacterial infections. But sometimes, there’s no clear cause.
In addition to perineum pain, prostatitis can also cause:
pain or burning during urination
trouble urinating, especially at night
an urgent need to urinate
cloudy or bloody urine
pain in your abdomen, groin, or lower back
pain during ejaculation
Causes in females
Vulvodynia is chronic pain of the vulva, which is the external tissue around the opening of the vagina. It’s usually diagnosed if your doctor can’t find any other potential cause of your pain.
Its main symptom is pain in your genital area, including your perineum. This pain might be constant or come and go. In other cases, it might only occur when the area is irritated.
Other sensations you might feel in your perineum or genitals include:
pain when sitting or during intercourse
During a vaginal delivery, you may need an episiotomy. This is a surgical incision in your perineum that enlarges your vaginal opening, making it easier for a baby to exit the birth canal.
The perineum can also tear during the birthing process. If your doctor thinks your perineum might tear during the process, they may decide to perform an episiotomy. This incision usually heals better than a tear does.
As you heal, you may have perineum pain. This tear or incision can also become infected. Contact your doctor right away if you’ve recently given birth and notice any of the following symptoms in your perineum:
redness and swelling
an increasing level of pain
a foul smell