Perineal pain: 16 possible causes (and what to do?)

pelvic pain

Le perineum is an intimate area that can be affected by non-painful and quite embarrassing disorders such as urinary leakage, but also by painful pathologies. Perineal pain is therefore pain felt in the perineum, whatever its origin.

This type of pain is a frequent reason for consultation in medical specialties such as dermatology, proctology, gynecology, urology, neurology, etc. When these specialties are involved, they manage to identify an organic cause. In some cases, it may be perineal pain without a concrete cause.

One might think that these pains affect women more, but note that men are also affected. They are important to explore because they can affect the couple's sexual comfort. This article will try to give the 16 probable causes in case of perineal pain, and what are the different ways to remedy it.

What is the perineum?

The perineum is a set of muscles that are located on the lower wall of the pelvis. These muscles intertwine and form the bottom of the pelvis. They go from the pubic bone in front to the tailbone behind. The structure of the perineum is different for men and women.

It includes the lower end of the digestive, urinary and genital tracts. In women, the urogenital triangle includes the opening of the vagina and the clitoris. In humans, it includes the root of the penis, the scrotum and the shaft of the penis.

The role of the perineum is to support the lower digestive tract, the urinary tract by ensuring the closure and opening of the bladder and finally the genital tract, thus ensuring urinary and fecal continence. The organs located in the abdomen generate pressure variations when they fill, empty or contract. The role of the perineum is to exert upward resistance pressure in order to maintain balance. permanent. Finally, the muscles of the perineum are involved in sexuality.

Perineal pain in women

The woman feels at the level of the perineum and further, at the level of the vagina, pain and also itching, burning or irritation, heaviness, tightness, even electric shocks. The pain may be increased after going to the toilet (stool), and the woman may suffer from constipation. The suffering can also go up to the level of the lumbar.

These pains have a significant impact on sexual life, ranging from moderate pain to an inability to have penetrative intercourse.

1. Pregnancy

The perineum is a part of the anatomy of the pregnant woman that is quite stressed. During pregnancy, a woman's body undergoes changes. Under the effect of weight gain and the shift in gravity, abdominal pressure increases on the pelvic floor, which can weaken the perineum and lead to pain.

2. Childbirth or endovaginal surgery

The perineum undergoes the pressure of the contractions of the uterus during childbirth, then a very significant relaxation after the birth of the baby. In addition, the perineum can be injured when the baby has a high weight, when a episiotomy is practiced or in the event of instrumentalization (forceps).

These traumas can lead to complications such as perineal pain. Beyond these pains, there can also be incontinence, pain during sexual intercourse or organ descents.

3. Pain in the perineum during or after sex

Perineal pain that occurs during or after intercourse is called dyspareunia. This pain can have several causes:

  • endometriosis : It is the abnormal presence of uterine tissue outside the uterine cavity. If these endometrial cells are found in the bladder and rectum, then they can cause perineal pain under the influence of reproductive hormones.
  • the presence of ovarian cysts
  • a sexually transmitted infection (IST)
  • le vaginismus : It's panic, fear of penetration leading to an involuntary contraction of the perineum preventing any penetration. Its origin is generally psychological, especially after sexual trauma, anxiety or stress.

perineal pain in men

In humans, several inflammatory pathologies are the cause of perineal pain.

4. Prostatitis : It corresponds to an inflammation of the prostate. When acute, it is more often of bacterial origin and constitutes a sexually transmitted infection. On the other hand, chronic prostatitis, which is more frequent, is generally non-bacterial and can be linked to a pathology of the prostate such as an adenoma (benign tumor).

THEchronic epididymitis and l'urethritis are also two other causes of inflammation in humans.

Causes common to both male and female

7. Pudendal neuralgia

It is an inflammation of the pudendal nerve. This nerve innervates the perineal area as well as other parts of the body like the urinary tract and the rectum. The pain caused by pudendal neuralgia take on a chronic aspect and become more intense when seated.

Other signs associated with pain are: discomfort during urination, defecation or sexual intercourse, urinary disorders, sensation of a foreign body in the rectum, incontinence, urinary leakage.

To know everything about pudendal neuralgia, see the following article.

8. The cyclist syndrome ou Alcock syndrome

Irritation or even compression of the pudendal nerve or internal pudendal nerve can occur after a large part of the weight of the body is supported by the perineum for long periods.

It follows a decrease in blood circulation at the level of the perineum (ischemia) and a compression of the channel d'Alcock (small space in the pelvis where the pudendal nerve passes). There is some numbness followed by eventual incontinence and erectile dysfunction.

9. Coccydynia

La coccydynia as its name suggests, is a pain localized to thecoccyx bone. It is then triggered in a sitting position when pressure is exerted on the coccyx externally or internally (rectal examination). It can sometimes be due to coccygeal instability that can be diagnosed by dynamic X-ray images (instability greater than 25° between standing and sitting is considered pathological).

However, when the coccyx remains stable, the pain may be due to a intercoccygeal osteoarthritis or an coccygeal spine.

To know everything about coccyx pain, see the following article.

10. Piriformis muscle syndrome

It comes from the contracture of the piriformis muscle which is inserted between the greater trochanter and the iliac bone. It translates into a buttock pain with descending irradiations to the posterior face of the thigh. These pains are aggravated when sitting, by physical exertion such as walking, lifting, climbing stairs.

Conversely, patients can be relieved in a seated position by passive flexion and abduction of the lower limb (resulting in muscle shortening).

To know everything about the piriformis syndrome, see the following article.

In addition, some non-specific pathologies can cause perineal pain in some cases. It's about:

11. Du obturator muscle syndrome

12. of the pelvic varicose veins

13. Du myofascial syndrome

What to do in front of perineal pain?

The causes of perineal pain being diversified, it is necessary to consult a specialist as soon as they appear, especially if they are persistent. This will allow for an accurate diagnosis and appropriate therapy.

If an infectious disease is at the root of the perineal pain, specific medications for the infection are offered. In addition, the pain management itself will involve several techniques.

Perineal rehabilitation

It relaxes the perineum and softens the painful area. It is performed by specialists (midwives, physiotherapists or osteopaths specialized in perineology). There are devices intended for this purpose called electro stimulators, equipped with relaxation/relaxation programs for the pelvic floor.

  • On the preventive level, we can encourage regular maintenance of the pelvic floor thanks to adapted massage oils, geisha balls (for women).
  • Do perineal gymnastics exercises with Swissball balls for example.
  • During childbirth preparation classes, pregnant women can benefit from simple advice to limit perineal pain, such as: perineal massage but also breathing exercises to strengthen the abdominal muscles. These exercises will allow the diaphragm to rise and thus reduce pressure on the pelvic floor.
  • It is also very important to make a postpartum perineal rehabilitation (after childbirth) in order to tone the perineum so that it regains all its functions.
  • In the case of pudendal neuralgia and coccydynia, the treatment essentially consists of carrying out infiltration.
  • Perineal pain may also require surgical intervention as in the case of pelvic varices.

Conclusion

Perineal pain is a symptom that is sometimes difficult to manage given the diagnostic uncertainties and the therapeutic problems encountered.

It is important to consult a specialist who will be able to find out if it is neuropathic pain, muscular, spinal, infectious, etc.

It is he who will be able to direct the patient towards appropriate care (medication, rehabilitation, surgery).

References

  1. https://www.fmcgastro.org/postu-main/archives/postu-2009-paris/les-douleurs-perineales-2/
  2. https://www.perineeshop.com/blog/index/billet/4709_douleur-perinee-homme-femme
  3. https://sante.journaldesfemmes.fr/fiches-anatomie-et-examens/2552720-perinee-definition-anatomie-comment-le-masser/
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