The Perineum and Pregnancy
Your perineum is the small area of skin and muscle located between the vagina and the anus.
By the third trimester of pregnancy, your baby is gaining weight and dropping lower in your pelvis. The added pressure can lead to swelling of the genitals and perineum. At the same time, your perineum is starting to stretch in preparation for childbirth.
A sore perineum due to pregnancy is a temporary problem, although it can be uncomfortable.
The perineum is further stretched during childbirth. It’s not uncommon for the perineum to tear as the baby passes through. According to American College of Nurse-Midwives (ACNM), anywhere from 40 to 85 percent of women have a tear during a vaginal delivery. About two-thirds of these women require stitches to repair the damage.
To decrease the chances of a ragged tear, your doctor may cut the perineum. This procedure is called an episiotomy. This gives the baby more room to pass through without causing severe tears.
Whether you experience a tear or have an episiotomy, the perineum is a delicate area. Even tiny tears can cause swelling, burning, and itching. A large tear can be quite painful. Episiotomy stitches can feel sore and uncomfortable.
The symptoms can last a few days to several months. During that time, it may be difficult to sit or walk comfortably.
Pregnancy and childbirth are the most common causes of a sore perineum in women. Other things can lead to a sore perineum, but it’s not always easy to find the cause.
Soreness of the vulvar area or perineum can be caused by something as simple as tight pants or sitting in an uncomfortable position for too long. Intercourse without sufficient lubrication can also cause a sore perineum.
Generalized vulvodynia is a chronic pain in the vulvar area but without an obvious cause. The pain can affect the entire area, including the labia, clitoris, and perineum.
Descending perineum syndrome occurs when the perineum balloons beyond its normal positioning. This might happen if you have an ongoing problem defecating or urinating and you strain too hard. If you have a descending perineum, the first step is to determine the cause.
It could also be referred pain. If you have unexplained pain, diagnosing the problem will probably start with a complete gynecological examination.
A 2013 study indicated that some women have a higher risk for certain types of perineal tearing during childbirth. Risk factors include:
- delivering a baby as an adolescent
- being 27 or older
- having a baby with a high birth weight
- having an instrumental delivery
Having more than one of these risk factors makes a perineal tear significantly more likely. If you have more than one of these risk factors, your doctor may consider an episiotomy to try and prevent a tear.
If you have a sore perineum, sitting can make it worse. One simple and inexpensive fix is a hemorrhoid or donut cushion to keep your weight off of your perineum when you sit.
Massaging the area during pregnancy may help relieve soreness and prepare the perineum for childbirth.
Some women find that using an ice or a cold pack relieves symptoms such as swelling, itching, and burning of the perineum.
A 2012 paper published in the Cochrane Library concluded that there’s only a small amount of evidence that cooling treatments are safe and effective in relieving perineal pain.
If you’ve experienced a tear or an episiotomy, your doctor will provide after-care instructions. It’s important that you follow them carefully.
They’ll probably give you a perineal irrigation bottle. You can use it to squirt warm water on the area to clean and soothe it, especially after going to the bathroom.
To help prevent infection, you’ll need to keep the area very clean. A warm, shallow bath may help temporarily relieve discomfort. Use a clean towel to pat yourself dry rather than rubbing the area. You shouldn’t have a bubble bath or use other products with harsh ingredients until it’s completely healed.
How much soreness you have and how long it will last can vary depending on the person. It has a lot to do with the cause. If you’ve had extensive tearing and swelling, it may take longer to heal.
For most women, childbirth-related soreness of the perineum subsides within a few days to a few weeks. There are usually no long-term effects.
See your doctor if the soreness doesn’t seem to be improving or it’s getting worse. You should also call your doctor if you have:
- a fever
- foul-smelling discharge
- perineal bleeding
- difficulty urinating
- severe pain
- problems with perineal stitches
If you’re prone to perineal soreness, try to avoid wearing pants that are too tight. You should also make sure you’re well lubricated before having intercourse.
If you’re pregnant, you might benefit from a perineal massage. According to Brighton and Sussex University Hospitals, studies show that in a first pregnancy, perineal massage after the 34th week can reduce perineal tearing.
To prepare for massage, the ACNM suggests you cut your fingernails short and wash your hands well. Relax with your knees bent. Use pillows for added comfort.
You’ll need to lubricate your thumbs as well as the perineum. You can use vitamin E oil, almond oil, or vegetable oil. If you prefer, you can use a water-soluble jelly. Don’t use baby oil, mineral oil, or petroleum jelly.
- Insert your thumbs about 1 to 1.5 inches into your vagina.
- Press down and to the sides until you feel it stretch.
- Hold for one or two minutes.
- Use your thumbs to slowly massage the lower part of your vagina in a “U” shape.
- Concentrate on keeping your muscles relaxed.
- Massage the perineum this way for about 10 minutes per day.
If you’re not comfortable doing it yourself, your partner can do it for you. Partners should use the same technique, but with index fingers instead of thumbs.