The perineum or perineal area is the area that separates the anus from the genitals. The area is mainly made up of muscle, but has highly sensitive skin. Therefore, the perineum is also known as the erogenous zone.
What is the perineum?
The perineum is the tissue that separates the anus from the genitals. The male perineum extends from the anus to the base of the scrotum. The female extends from the anus to the insertions of the labia majora. The anogenital distance is a unit of measurement that measures the distance between the anus and the root of the penis or vagina. Studies have shown that this distance is twice as long in men as in women. Its measurement has been proposed as a non-invasive method to detect early male feminization in newborns. In this way, a statement can be made about the likelihood of reproductive dysfunction at a young age and also in adults. Lacerations and cuts often occur during child birth. However, the perineum can be prepared for this excessive stress by massage.
Anatomy and structure
The perineum lies below the pelvic floor and is located between the legs. It is a tissue district in the shape of a diamond between the anus and vagina or anus and testicles. Its definition varies, as it can denote only the external structure, but can also include the deeper structures below the skin. It is an erogenous zone for both men and women, as many nerves converge here. The perineum is the central part of the perineal region. Mainly, it consists of muscles that belong to the pelvic floor musculature. This is divided into two parts, namely muscles of the urogenital region and muscles of the anal region. The skin and sub-tissues that cover it have many branches of the pubic nerve running through them. This makes the perineum a sensitive region of the body. It is supplied with blood by the internal iliac artery, which branches off indirectly from the aorta.
Tasks and function
The function of the perineum is first to separate the genital area from the anal area. This prevents bacteria from the intestines from entering the vagina. At the same time, the three layers of pelvic floor muscles converge in it to stabilize the body and ensure continence. It also acts reflexively against it when sneezing, coughing, laughing, bouncing or carrying heavy loads to prevent incontinence. The perineal skin is elastic so that it can react flexibly to the size of the penis or stool during both sexual intercourse and defecation. Because many nerve branches meet in this small part of the body, the perineum is considered an erogenous zone. Massaging or applying pressure to this zone can be arousing. In men, an erection can be enhanced by applying pressure to the perineum. When it is touched, the external anal sphincter contracts reflexively. This is called the perineal reflex.
Diseases and complaints
During childbirth, the perineum may tear due to the great pressure of the baby’s head or shoulder. There are different classifications for this, each indicating a different degree of severity. Grade one means that there are tears in the posterior vaginal skin. Grade two means that the tissues of the perineum are torn. Grade three involves the sphincter of the bowel, and grade four involves both the sphincter and the anus. In this area, inflammation and heavy bleeding occur very rarely. As a precautionary measure, an episiotomy is performed in some births if the perineal tissues do not stretch far enough, the child suffers from oxygen deprivation, the child is premature and therefore not yet capable of bearing weight, or the child is born in a breech presentation. In many cases, an episiotomy must also be performed during a forceps or vacuum birth. This is done during a contraction, when the mother feels only this one pain. After birth, both the perineal tear and the episiotomy are sutured under a local anesthetic. The healing process can be painful and is often associated with restrictions on sitting as well as bowel movements and urination. It usually takes six weeks, because by then most of the stitches will have dissolved. However, a good midwife can remove them before then, if the wound has healed appropriately.In the case of vulvar carcinoma, i.e. a type of cancer in the vagina, the perineum can also be affected. Signs of this are itching and reddened areas in the vagina and perineum. Pain during sexual intercourse as well as during defecation or urination may also indicate this. Pelvic floor prolapse, which becomes more likely with age, causes the internal organs of the pelvis and abdomen to sag. Especially women who have had many or heavy births are at increased risk for this. It is noticeable by voiding dysfunction or sphincter weakness. Back pain in the lumbar region is also not uncommon.
