The perineum is the area of the body located between the anus and the genitals. In females, this region extends from the anus to the vulva, while in males, it stretches from the anus to the scrotum. Perineum pain, which can range from a dull ache to sharp, intense pain, and be constant or intermittent, refers to discomfort or soreness in this specific anatomical region.
Trauma and Injury
Perineum pain can arise from trauma or injury to the area. Childbirth is a common cause, where vaginal delivery can lead to perineal tearing or require an episiotomy, a surgical incision to enlarge the vaginal opening. The healing process after these events can involve significant pain in the perineum for several weeks or even months postpartum.
Impact injuries, such as falls or sports-related incidents, can also cause acute perineal pain. Activities that involve prolonged pressure on the perineum, like extended cycling or horseback riding, may lead to temporary or persistent soreness due to compression. Surgical procedures in the pelvic or perineal region, including prostatectomy, hemorrhoidectomy, or certain gynecological surgeries, can result in post-operative pain as the tissues heal.
Infections and Inflammation
Infections and inflammatory conditions are a common source of perineum pain. Urinary Tract Infections (UTIs) can cause discomfort in the perineal region, alongside other urinary symptoms. Yeast infections may also cause itching and irritation that extends to the perineum. Sexually transmitted infections (STIs) can also lead to inflammation and pain in this area.
Localized infections, such as abscesses, can form in the perineum, causing throbbing pain and swelling. Examples include Bartholin’s gland cysts or abscesses in females (near the vaginal opening), or perianal abscesses that develop near the anus. Inflammatory conditions like prostatitis (inflammation of the prostate gland in males) often present with perineal discomfort. Vulvodynia, chronic vulvar pain without an identifiable cause, can also result in perineal pain in females. Less commonly, conditions like interstitial cystitis (a chronic bladder pain syndrome) or inflammatory bowel diseases such as Crohn’s disease, especially when affecting the perianal area, can contribute to perineum pain.
Nerve and Muscle Issues
Perineum pain can also stem from nerve or muscle issues in the pelvic region. Nerve entrapment or irritation, such as pudendal neuralgia, occurs when the pudendal nerve (which supplies sensation to the perineum) becomes compressed or damaged. This can lead to burning, aching, or numbness in the area.
Pelvic floor dysfunction is a significant contributor, often involving muscles that are overly tight (hypertonic) or unable to relax. This constant tension can create painful trigger points within the pelvic floor muscles, radiating to the perineum. Muscle spasms in these deep pelvic muscles can also cause sharp, intermittent pain.
Pain originating from other areas of the body can be referred to the perineum. Issues in the lower back, such as sciatica (where nerve roots are compressed), can cause radiating pain felt in the perineal region. Similarly, problems with the hips or the sacroiliac joint (which connects the spine to the pelvis) can refer pain to the perineum, making diagnosis challenging.
Other Medical Conditions and External Factors
Several other medical conditions and external factors can contribute to perineum pain. Anorectal issues are a common cause, including hemorrhoids (swollen veins) and anal fissures (small tears in the lining of the anus). Proctalgia fugax, brief, severe rectal pain spasms, can also be felt in the perineal area.
Rarely, growths or cysts (e.g., perineal cysts or tumors) can cause localized discomfort. Systemic conditions like endometriosis, where uterine-like tissue grows outside the uterus, can cause pelvic pain that may extend to the perineum. Certain autoimmune conditions can also lead to inflammation and pain in the pelvic region.
Lifestyle factors can also play a role. Chronic constipation and straining during bowel movements can put pressure on the perineum, leading to soreness. Prolonged sitting on hard surfaces can exert continuous pressure on the perineal tissues, resulting in discomfort. Additionally, side effects from radiation therapy targeting pelvic cancers can cause lasting pain in the perineum due to tissue damage and inflammation.
When to Seek Medical Attention
Seek medical attention if perineum pain is persistent, worsening, or significantly interferes with daily activities. Also seek medical attention if the pain is accompanied by concerning symptoms like fever, chills, unusual discharge, or difficulty with urination or defecation.
Sudden, severe perineum pain warrants immediate medical evaluation. Numbness or weakness in the perineal region or surrounding areas also warrants prompt assessment. A healthcare provider can determine the underlying cause and guide appropriate treatment.