Itching or burning sensations in the perineal area can cause extreme discomfort that make sitting and sleeping difficult.
Potential causes range from infections to nerve damage, and sometimes the cause is unknown. Fortunately, there are many preventive and treatment approaches that can help you reduce perineal itching.
Learn what might cause an itchy perineum and how to treat it.
When should I seek medical care?
While we provide some general at-home remedies, don’t hesitate to seek medical care. A doctor can diagnose the cause, and provide targeted treatment that will clear up underlying conditions and reduce discomfort.
The perineum is the area of skin between the vagina and anus in women and the scrotum and anus in men.
In women, the perineum is the protective covering for the perineal muscles that work with other key muscles and ligaments to hold the pelvic organs in place. The pelvic organs include the bladder, rectum, vagina, and uterus. There are also blood vessels underneath the perineum.
In men, the perineum protects the underlying pelvic floor muscles and blood vessels as well. The perineum is also responsible for covering nerves a man’s body uses in order urinate or achieve an erection.
This area is a common source of itching and discomfort in both genders for a variety of reasons, ranging from skin irritation to underlying medical conditions.
Here are the common causes of burning or itching in the perineum.
Pruritus ani is a condition that can occur in both genders, but is most common in men. The condition causes an itching sensation in the anal area that can be an acute or chronic occurrence.
Acute pruritus (itching) may be due to contact dermatitis, such as from a new laundry detergent or soap, or from fungal or bacterial infections. Waxing burns and shaving injuries can also cause the condition.
Chronic pruritus ani in men can have many causes. These include atopic dermatitis, diabetes, basal cell carcinomas, and other causes. Sometimes, the cause is idiopathic, meaning a doctor can’t identify the underlying cause.
Sexually transmitted infection
Itching around the anal and perineal area can be a sexually transmitted infection (STI) symptom. Conditions that can cause this symptom include:
These conditions don’t always cause symptoms you can easily see. For this reason, it’s a good idea to see a doctor.
A doctor can perform a physical examination and testing to determine the most likely cause. Treatment is available for each condition that can reduce your symptoms and the likelihood of passing the condition on to a partner.
Straddle injuries are those that occur from experiencing trauma to areas between the thighs, including the perineum. This may occur from falling on a bicycle crossbar, fence, gym equipment, or bathtub’s edge.
This injury type can cause burning in the perineum due to nerve damage or swelling in the area that affects nerves. Ideally, this injury and its symptoms will resolve with 2 to 3 days of rest, cold compresses to the affected areas, and taking over-the-counter pain relievers.
Causes affecting women
Some perineal itching and pain may specifically affect women. Examples of these include:
- Post-episiotomy/tear pain. An episiotomy is a surgical cut made to facilitate childbirth if the vaginal opening is not large enough. Some women who undergo an episiotomy or tear after childbirth can experience nerve damage, pelvic floor disorders, and problems passing stool, especially immediately after giving birth. These can affect the perineum, leading to itching or burning during the healing process.
- Yeast infections. Women are especially vulnerable to yeast infections, which is an overgrowth of the fungus Candida. Symptoms include vaginal itching that can extend to the perineal area, pain during sex, and pain upon urination. Doctors can treat yeast infections through prescribing oral or topical anti-fungal medications.
- Hormone-related tissue thinning. As a woman enters menopause, the natural estrogen decline can lead to thinning tissue in the vagina and perineal area. This may make the area more vulnerable to itching.
These are just some examples of common perineal itching or burning causes affecting women. If you’re concerned you may have another related condition, contact your doctor.
Causes affecting men
Some causes of perineal burning and itching may affect men specifically. These include:
- Surgical history. If a man has had surgery, such as to remove the prostate or repair a urethral stricture, his surgeon may have cut the perineum to access key areas. This can lead to itching and burning if the surgery damaged nerves in the process.
- Fournier’s gangrene. Although a rare occurrence, this serious infection occurs in the male genital region, including the perineum. The condition can result from trauma, surgical history, or as an after-effect of another infection (such as a urinary tract infection).
Chronic bicycle, motorcycle, or horseback riding can also cause chronic damage to the perineal nerves.
If doctors can identify the underlying cause of itching in the perineum, they’ll direct their treatments accordingly. However, sometimes a doctor can’t determine a specific underlying cause. When this is the case, some of the general treatments include:
- Take an over-the-counter antihistamine (such as Benadryl), especially at night when itching tends to worsen.
- Apply cool compresses to the perineal area to soothe burning sensations.
- Apply emollient or barrier creams to the anal area to protect against irritation from stool or urine. Examples include petroleum ointments or a zinc oxide ointment.
- Wear clean, breathable underwear washed in a gentle, nonirritating soap.
Sometimes, a doctor will prescribe medications in addition to recommending antihistamines as a way to break the itch-and-scratch cycle that can keep a person up at night. Examples of these medications may include gabapentin and selective serotonin reuptake inhibitors (SSRIs).
A note about topical steroids
When you have an itchy perineum, it’s natural to contemplate treating the itch with topical corticosteroids. These anti-itch creams can work well on other parts of the body, but applying them to the perineum isn’t the best choice. Steroid itch creams can have a skin-thinning effect, which could worsen symptoms or create new ones.
For this reason, don’t apply steroid creams to the perineal area unless your doctor recommends it.
While it’s not always possible to prevent itching in the perineum, there are some steps you can take to reduce the likelihood that itching will occur. These include:
- Avoid vigorous rubbing when cleansing the anal area after having a bowel movement.
- Change underwear immediately after exercising to reduce sweat irritation of the perineal area.
- Eat a high-fiber diet and drink plenty of water to reduce the incidences of constipation.
- Refrain from using hot water when taking a bath or shower.
- Use mild, fragrance-free cleansers to clean the genital area.
Ask your doctor if there are specific preventive approaches you can take given the underlying cause of your perineal discomfort.
Perineal itching may be an uncomfortable topic to talk about, but it’s often more uncomfortable to experience.
If preventive methods or at-home treatments haven’t helped (or you’re worried you have an infection), talk to a doctor. They can help determine potential causes and help you feel more comfortable.