The area between the anus and the vulva/vagina in women and the scrotum in men is called the perineum. The perineum is also called ‘buttocks’, not to be confused with ‘buttocks’. The perineum consists mainly of muscle and skin, and the area is considered an erogenous zone for both sexes. In this article we discuss a number of possible causes of perineal pain in both men and women. In men, perineal pain can be associated with prostate conditions. A feeling of pressure or pain in the perineum can occur in women after pregnancy. Another possibility of pain in the perineum is nerve compression around the anus or pubic area. This can occur in both men and women.
Possible causes of perineal pain include:
- Renal pelvic inflammation
- Pudendal nerve entrapment (PNE)
- Perineal trauma due to childbirth
- Abscess of Cowper’s glands
- Benign prostate enlargement
- Prostate cancer
Renal pelvic inflammation
Women and men
If a bladder infection is not treated in time, the bacteria can ‘ascend’ from the bladder to the kidney, causing a renal pelvic infection or pyelonephritis. A bladder infection is very common in women and much less so in men and is a superficial inflammation of the mucous membrane in the bladder. You often suffer from a painful or burning sensation when urinating, pain in the lower abdomen or hematuria (blood in the urine), regular urge to urinate and you often urinate small amounts. Often you do not have a fever, but sometimes you do have a fever. If the infection spreads to the kidney tissue or prostate tissue (see below), you will feel ill, have a high fever accompanied by chills, feel nauseous, and have pain in the flank or perineum. Complaints when urinating may then be absent.
Pudendal nerve entrapment (PNE)
Women and men
PNE indicates nerve compression around the anus or pubic area, which leads to chronic pain in the area supplied by a specific nerve, the pudendal nerve. This pain worsens when you sit down.
Perineal trauma due to childbirth
The perineum is the part where laboring women can possibly tear during childbirth or where an episiotomy (‘cut’) is made if this is necessary. In that case, the perineum is swollen and has stitches. This often involves suture that resolves itself after a maximum of two weeks. A woman who has given birth cannot only suffer from perineal problems due to cutting or tearing. Many women experience pain in the perineum after giving birth. The extent and severity of the complaints depends on how difficult the birth was. If your baby comes out easily after a few pushes without cutting or tearing, then the pain is probably not too bad. But if you pushed for two hours and a big baby came out, there’s a good chance you’re going to have a lot of trouble.
What causes this pain? First, the baby passing through the birth canal has stretched the tissues, making them somewhat swollen and painful. A cut or tear in the perineum also hurts. The pain is worst during the first few days after giving birth, but then it subsides and the pain often disappears within a week. A pregnant woman can prepare for this by regularly massaging the perineum with special massage oil, which helps to make this area more flexible and better able to move during childbirth.
Abscess of Cowper’s glands
The Cowper’s glands, also called ‘Cowper’s glands’ or ‘glandulae bulbourethrales’, are two pea-shaped glands near the prostate. These glands secrete precum during sexual arousal – some time before the man ejaculates – even before the semen leaves the body via the urethra. The sticky fluid produced neutralizes any residual urine in the urethra, preventing the death of sperm cells in the urethra. These glands can become infected, after which an abscess forms. This is often due to a sexually transmitted disease, such as gonorrhea or chlamydia. Such an abscess is very painful and initially the pain is felt in the perineum. In addition, you may from time to time suffer from fever with chills. Not infrequently, pus comes out of the penis and urination becomes difficult and painful. You may feel swelling on the left and/or right side of the perineum. If you touch this swelling you will feel pain.
Benign prostate enlargement
A benign enlarged prostate or benign prostate hyperplasia (BHP) is common in men over the age of fifty. It turns out that almost half of all men have an enlarged prostate around the age of sixty. It is often a benign enlargement. The causes of benign prostate enlargement are not yet precisely known. A benign prostate enlargement can cause complaints if the prostate presses against the urethra. These complaints may include:
- a less powerful urine stream and/or an interrupted stream;
- difficulty initiating urination;
- increased urge to urinate;
- needing to urinate more often;
- unwanted urine loss (incontinence);
- urinating more often at night;
- feeling that the bladder is not emptying.
Prostatitis or prostatitis refers to an inflammation of the prostate gland, which can be chronic or acute. The acute form is not that common and often manifests itself with sudden, serious symptoms. The chronic variant is much milder in nature and causes moderate symptoms for a longer period of time. The symptoms vary and depend on the cause. Complaints that may occur with prostate inflammation are:
- Pain or burning sensation when urinating (dysuria);
- Difficulty urinating, such as less strong urine stream and/or an interrupted stream;
- Frequent urination, especially at night (nocturia);
- Urgent need to urinate;
- Abdominal pain, pain in groin or lower back;
- Pain in the area between the scrotum and the anus (perineum);
- Pain or discomfort in the penis (penile pain) or testicles (testicle pain);
- Painful orgasms (ejaculations);
- Flu-like symptoms (with bacterial prostatitis).
Much less often, pain in the perineum in men is caused by prostate cancer. The symptoms that may indicate prostate cancer are:
- frequent urination, especially at night;
- difficulty urinating;
- weak or interrupted urine stream;
- painful urination or a burning sensation during urination;
- difficulty getting an erection (an erect penis);
- painful ejaculation (pain during ejaculation);
- blood in the urine or semen;
- frequent pain or stiffness in the lower back, hips, or thighs.
- Prostate pain and prostate complaints: prostate (pain) complaints
- Pain during urination in men and women: symptoms and causes
- Perineal pain (sore perineum): symptoms and causes
- Pain in the anus or anal pain: causes of painful anus
- Perineum: function, anatomy and disorders of the perineum