Perineum: Location, Anatomy, Function and Common Conditions
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is the perineum?
The perineum is the patch of skin between the genitals and anus, along with deeper tissues at the bottom of the pelvic cavity. It contains nerves, muscles and connective tissue, supports the pelvic floor and contributes to sexual sensation, urination and bowel movements. Pain is the most common sign of a problem, along with itching, a lump or swelling. [1]
What the research says
Antenatal perineal massage lowers the chance of trauma needing stitches. A Cochrane review of 4 trials (2,497 women) found that digital perineal massage in the last weeks of pregnancy reduced trauma requiring suturing (RR 0.91, 95% CI 0.86–0.96; about 1 fewer in 15 women) and episiotomy (RR 0.84, 95% CI 0.74–0.95). The benefit was significant only for women without a previous vaginal birth, and there was no difference in first- or second-degree tears or in third- and fourth-degree trauma (Beckmann and Stock, Cochrane Database Syst Rev, 2013). [2]
Massage during labor was linked with fewer severe tears. In a meta-analysis of 9 trials (3,374 women), perineal massage by a clinician during the second stage of labor reduced severe (third- and fourth-degree) perineal trauma (RR 0.49, 95% CI 0.25–0.94), increased the chance of an intact perineum (RR 1.40, 95% CI 1.01–1.93) and reduced episiotomy (RR 0.56, 95% CI 0.38–0.82) (Aquino et al., J Matern Fetal Neonatal Med, 2020). [3]
Selective use of episiotomy is supported over routine use. A Cochrane review of 12 studies (6,177 women) found that, where an unassisted vaginal birth was expected, a selective episiotomy policy may result in 30% fewer women with severe perineal or vaginal trauma (RR 0.70, 95% CI 0.52–0.94; low-certainty evidence), with no clear evidence of harm to mother or baby (Jiang et al., Cochrane Database Syst Rev, 2017). [4]
Where is the perineum located?
The visible perineum is the small area of skin between the genitals and anus. Internally, the perineum lies below the main pelvic-floor muscle, the levator ani, and stretches across the pelvic bones. [1]
Its boundaries can be described using three landmarks: the pubic symphysis at the front, the tailbone or coccyx at the back, and the right and left sitz bones, also called the ischial tuberosities, at the sides. [1]
Boundary | Anatomical landmark |
Front | Pubic symphysis, the joint connecting the left and right pelvic bones. |
Back | Tailbone, or coccyx. |
Sides | Right and left sitz bones, or ischial tuberosities. |
What is the perineum’s structure?
The perineum is often drawn as a diamond. An imaginary line between the two sitz bones divides that diamond into two triangular regions: the urogenital triangle and the anal triangle. [1]
The urogenital triangle contains the genitals (see the guides to the vagina and urethra), the urethra and associated muscles. The anal triangle contains the anus and anal sphincter, the muscle that helps the anus squeeze and relax during bowel movements. [1]
A tough mass of fibromuscular tissue called the perineal body sits where the two triangles meet. It helps support the pelvic floor and can be injured during childbirth. [1]
How large is the perineum?
The average perineum is about 1.5 inches long in females and about 2 inches or more in males. Individual anatomy varies, so these figures should not be used to judge whether a person’s body is normal. [1]
What is the perineum made of?
Under the skin are multiple layers of connective tissue, fatty tissue, muscles and membranes. The pudendal nerve runs through the perineum and branches to the genitals, pelvic floor muscles and anus. This nerve network contributes to the area’s sensitivity and helps with urination and bowel movements. [1]
What does the perineum do?
The perineum is an erogenous zone because its skin contains multiple nerve endings involved in sexual arousal and response. Its deeper structures also contribute to urination, bowel movements and intercourse. [1]
The perineum forms a foundation for the pelvic floor muscles. Those muscles help hold organs such as the bladder, colon and reproductive organs in place. In people who give birth vaginally, the perineum contains structures that help with vaginal birth. [1]
What can cause perineal pain or injury?
Perineal pain or injury can be caused by childbirth tears, prostate inflammation or surgery, pelvic floor dysfunction, cysts or abscesses, hemorrhoids and pudendal nerve entrapment.
Childbirth and perineal tears
Childbirth is the most common cause of perineal injury. About 85% of people who give birth vaginally experience a torn perineum. Most tears are minor and heal over time, while some require stitches. Major tears can damage nearby pelvic floor muscles or the anal sphincter and may make peeing, pooping or intercourse difficult. [1]
An episiotomy is a cut made in the perineum before delivery to make the vaginal opening wider. Episiotomies are becoming less common because evidence suggests they may increase the likelihood of pelvic pain and incontinence after delivery for some people. [1]
Prostate inflammation and surgery
In males, prostatitis, or prostate inflammation, can cause pain felt in the genitals and perineum. Surgery for the prostate, tumor removal or repair of a urethral stricture may also involve cutting through the perineum. [1]
Pelvic floor dysfunction
Injury to the perineum can increase the likelihood of trouble peeing or pooping related to pelvic floor dysfunction. [1]
Cysts and abscesses
Perineal cysts or abscesses can become infected. They are often red, swollen and painful. [1]
Hemorrhoids
Hemorrhoids are swollen veins in the rectum or anus. They may cause bleeding, itching or pain in the perineum. The pain can radiate toward the rectum and worsen during or immediately after a bowel movement. [1]
Pudendal nerve entrapment
If the pudendal nerve becomes injured and inflamed, pain may appear suddenly or develop gradually over several weeks or months. [1]
Referred pain
Pain can sometimes radiate to the perineum from a condition that began elsewhere. Appendicitis, colitis and some gastrointestinal disorders are examples. [1]
Fournier’s gangrene
Fournier’s gangrene is a rare bacterial infection that causes the skin of the genitals and perineum to die. It is more common in males in their 50s and 60s who have diabetes. [1]
Pressure, trauma or violence
Motorcycling, cycling and horseback riding can injure the perineum. For cyclists, a noseless bicycle seat can remove pressure from the area and reduce injury risk. A torn perineum may also be a sign of sexual abuse or violence. [1]
Cause or condition | Summary |
Vaginal childbirth | Stretching and tearing; some tears need stitches. |
Episiotomy | A surgical cut that widens the vaginal opening before delivery. |
Prostatitis | Prostate inflammation that may cause pain in the perineum. |
Cyst or abscess | May be infected, red, swollen and painful. |
Hemorrhoids | May cause bleeding, itching or pain. |
Pudendal nerve entrapment | Can cause sudden or gradually developing perineal pain. |
Referred pain | Appendicitis, colitis and some gastrointestinal disorders may radiate pain to the perineum. |
Pressure or trauma | Cycling, motorcycling and horseback riding can injure the area. |
What are common symptoms of a perineal problem?
Pain is the most common sign that something may be wrong with the perineum. After childbirth, pain from a tear can make walking or sitting difficult. [1]
Other symptoms can involve the perineum itself or nearby muscles and organs. They include trouble peeing or pooping, a sore or itchy perineum, difficulty getting an erection, pain with urination or intercourse, and a lump with redness or swelling. [1]
Symptom | Possible context |
Pain | Common sign; may affect sitting or walking after childbirth. |
Trouble peeing or pooping | May occur with perineal injury or pelvic floor problems. |
Soreness or itching | Can occur with a perineal condition or hemorrhoids. |
Pain with urination or intercourse | May indicate involvement of nearby structures. |
Lump, redness or swelling | Can occur with a cyst, abscess or another condition. |
Difficulty getting an erection | Listed as a possible symptom of a perineal problem. |
Symptoms alone do not establish a diagnosis. A healthcare professional can examine the area and decide whether testing is appropriate.
How are perineal conditions evaluated?
A healthcare professional may check for an injury, infection or another condition with a physical examination. The examination can include a digital rectal exam, in which a gloved finger is placed in the rectum to feel for irregularities. [1]
Imaging may help evaluate internal injury or damage to nearby structures. CT, MRI, ultrasound and X-ray with dye are possible tests. [1]
Test | What it may show |
CT scan | Internal injury to the perineum. |
MRI | Damage to blood vessels or muscles. |
Ultrasound | Damaged blood vessels. |
X-ray with dye | Damage to the urethra, which passes through perineal tissue. |
How are perineal conditions treated?
Treatment depends on the cause and severity. A clinician can assess a cut or tear and decide whether stitches are needed. Pain-management strategies may ease symptoms during healing.
Comfort and hygiene measures
Sitz baths and warm compresses are commonly used. A sitz bath is a shallow, warm-water bath that cleans the perineum and may aid healing. It is typically used twice daily for at least five to ten minutes, patting the area dry rather than scrubbing. [1]
Pain medicines and numbing sprays, hemorrhoid wipes or creams, and a peri-bottle for gently spraying warm water after using the bathroom are also used. Medication and product choices should be discussed with a healthcare professional, particularly after childbirth, an injury or when other health conditions are present. [1]
Constipation prevention
Straining during bowel movements may worsen perineal pain. A high-fiber diet and drinking at least eight cups of water daily can help prevent constipation. Individual fluid and dietary needs vary, so a clinician can help tailor advice. [1]
Pelvic floor exercises
Pelvic floor exercises, including Kegel exercises, may help the body heal and rebuild after childbirth-related tears. A healthcare professional may refer someone to a physical therapist for specialized exercises. Kegels should be attempted after an injury only with a provider’s guidance. [1]
Treatment for infection or more severe conditions
A healthcare professional may prescribe antibiotics or drain an infected cyst. Surgery may be needed for severe hemorrhoids or nerve damage in the perineum. [1]
Can perineal massage reduce tearing during childbirth?
Perineal tearing cannot be completely prevented, but massaging the perineum before childbirth and during delivery may reduce the likelihood of tearing or of needing stitches. [1]
A commonly described approach begins around week 34 of pregnancy, with five-minute sessions three to four times a week and clean hands. Because pregnancy and birth plans are individual, discuss whether perineal massage is appropriate and how to perform it with a qualified maternity-care professional. [1]
When should you contact a healthcare professional?
Contact a healthcare professional for persistent or significant perineal pain, a tear that may need assessment, trouble peeing or pooping, a painful lump, redness or swelling, or pain with urination or intercourse. Evaluation is also appropriate when symptoms follow childbirth, surgery, trauma or an activity that puts pressure on the perineum.
A torn perineum may be a sign of sexual abuse or violence. If this may apply to you, consider contacting a trusted healthcare professional or local support service in a way that feels safe.
Fournier’s gangrene is a rare infection that causes genital and perineal skin to die. It is a medical emergency: call 911 or go to the emergency room for severe or rapidly spreading pain, swelling or skin color change in the genitals or perineum, especially with fever or feeling very unwell.
Conclusion
The perineum is more than the small visible area between the genitals and anus. It also includes deeper tissues, muscles, membranes and nerves that contribute to pelvic support, sexual sensation, urination and bowel movements.
Pain, tearing, itching, swelling, a lump or difficulty with urination, bowel movements, intercourse or erections can have several possible causes. A healthcare professional can assess the symptoms, decide whether tests are needed and guide care. Use this guide to prepare questions for a clinician.
Frequently Asked Questions
What is the perineum?
The perineum is the skin between the genitals and anus. The term can also include the deeper tissues forming the bottom of the pelvic cavity.
Where is the perineum located?
The perineum is between the genitals and anus. Internally, it lies below the levator ani and stretches across the pelvic bones.
What are the perineum’s boundaries?
The pubic symphysis is at the front, the tailbone is at the back, and the sitz bones form the sides.
What are the two triangles of the perineum?
The urogenital triangle contains the genitals, urethra and associated muscles. The anal triangle contains the anus and anal sphincter.
What is the perineal body?
The perineal body is a tough mass of fibromuscular tissue where the urogenital and anal triangles meet. It helps support the pelvic floor and can be injured during childbirth.
What does the perineum do?
The perineum contributes to sexual sensation, urination, bowel movements and intercourse. It also forms a foundation supporting the pelvic floor muscles.
What is the most common cause of perineal injury?
Childbirth is the most common cause. About 85% of people who give birth vaginally experience a torn perineum.
What does a perineal tear feel like?
Pain is common. After childbirth, a tear may make walking or sitting difficult. Depending on the injury, it may also affect urination, bowel movements or intercourse.
Can perineal pain come from somewhere else?
Yes. Referred pain from appendicitis, colitis and some gastrointestinal disorders can radiate to the perineum.
Can cycling injure the perineum?
Yes. Cycling, motorcycling and horseback riding can injure the area. A noseless bicycle seat can reduce pressure and injury risk for cyclists.
How is a perineal problem evaluated?
Evaluation may include a physical examination and, when needed, a digital rectal exam or imaging such as CT, MRI, ultrasound or X-ray with dye.
What can help a healing perineum?
Sitz baths, warm compresses, pain-management strategies, gentle cleaning with a peri-bottle and constipation prevention can help. Kegel exercises after an injury should be attempted only with clinician guidance.
Does perineal massage prevent tears during childbirth?
Perineal massage cannot prevent every tear. Research suggests massage may reduce trauma requiring stitches and episiotomy, and massage during delivery may lower the risk of severe tears. Discuss it with a qualified maternity-care professional.
When should I seek care for perineal pain?
Contact a healthcare professional for persistent or significant pain, a tear, trouble peeing or pooping, a lump, redness or swelling, or pain with urination or intercourse. Severe or rapidly worsening symptoms need prompt medical assessment.
Related Reading
Understanding Vaginal Tears During Childbirth: Grades, Recovery, and Care explains perineal tears during birth and how they heal.
Pelvic Floor Muscles: Anatomy, Function, Dysfunction and Care covers the muscles that support the perineum and pelvic organs.
Pudendal Nerve: Function, Anatomy, Symptoms and Care describes the main nerve of the perineum and causes of its pain.
Prostatitis Guide: Symptoms, Causes, Diagnosis, and Treatment explains prostate inflammation that can cause perineal pain.
References
Cleveland Clinic. Perineum: Location, Anatomy, Function & Conditions. Cleveland Clinic. Updated October 26, 2022. https://my.clevelandclinic.org/health/body/24381-perineum
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;(4):CD005123. PMID 23633325. https://doi.org/10.1002/14651858.CD005123.pub3
Aquino CI, Guida M, Saccone G, et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2020;33(6):1051-1063. PMID 30107756. https://doi.org/10.1080/14767058.2018.1512574
Jiang H, Qian X, Carroli G, et al. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;(2):CD000081. PMID 28176333. https://doi.org/10.1002/14651858.CD000081.pub3
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional with any questions about a medical condition or treatment.
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