What is the Perineum?

The perineum is a region of the body that is often overlooked in discussions about human anatomy, yet it plays a crucial role in various bodily functions. It is important during pregnancy and childbirth. While the perineum exists in both male and female, our focus will be about what is the perineum in famales.

What is the perineum and where is it located?

The perineum is an anatomical region located in the pelvic area. It is the area between the pubic symphysis (the front part of the pelvis) and the coccyx (the tailbone). In women, it lies between the vulva and the anus¹.

The perineum's structure

The perineum is divided into two triangles by a line drawn transversely across the ischial tuberosities (the sitting bones). The anterior triangle, known as the urogenital triangle, contains the clitoris and the urethra. It also includes the vaginal opening. The posterior triangle, known as the anal triangle, contains the anus and the anal sphincter.

The perineum is supported by a muscular structure known as the perineal body, which serves as an attachment point for several muscles involved in urinary and fecal continence, as well as sexual function.

The perineum's functions

The perineum plays several important roles in the body:

1. Support: It provides support to the pelvic organs, including the bladder, intestines, and uterus.

2. Continence: The muscles of the perineum contribute to the control of urination and defecation.

3. Sexual function: The perineal body is involved in the tightening of the vagina during sexual intercourse⁴.

4. Childbirth: The perineum plays a crucial role in pregnancy and childbirth, is essential for maintaining the structural integrity of the pelvis, and its health and flexibility can significantly impact the birthing process.

The role of the perineum in pregnancy

The perineum plays a significant role during pregnancy and childbirth. It is the tissues of the perineum that create a strong pelvic floor, which not only allows you to walk upright but also prevents you from urinating every time you cough.

During childbirth, the perineum needs to stretch to allow the baby to pass through the birth canal. This stretching can sometimes lead to perineal trauma, such as tears (including severe 4th degree tears), or the need for an episiotomy.

Why does the perineum tear during childbirth?

Perineal tears during childbirth are a common occurrence and can happen for a variety of reasons. These tears are injuries to the tissue around the vagina and rectum and occur as the baby stretches the vagina and the perineum during birth¹. One of the primary causes of perineal tears is the baby's head being too large for the vagina to stretch around, or the vagina not stretching easily². Additionally, if the birth occurs so quickly that the skin hasn't had time to stretch and thin, this can also result in tearing. Assisted births, such as when forceps or a vacuum are used, can also contribute to tearing³. 

Perineal massage can help reduce the chances of tearing

It's important to note that while perineal tears are common, there are strategies to reduce the risk, such as perineal massage during pregnancy. This practice involves massaging the area between the vagina and anus during late pregnancy. Some women do perineal massage on their own and some with a partner. Others use approved perineal massage tools such as the Perimom Perineal Massager.

According to numerous clinical studies, perineal massage during the last weeks of pregnancy has a number of benefits such as reducing tearing at birth. Performing regular perineal massage from week 34 of pregnancy is proven to encourage the skin and muscles around the perineum to stretch more easily during childbirth.

Other strategies to reduce the chances of perineal tears during labor

1. Warm Compress: Placing a warm compress on the perineum during labor, particularly during the second stage when the baby's head is stretching the perineal tissues, can help reduce tearing during childbirth².

2. Birthing Positions: Certain birthing positions, particularly lateral or upright positions, can help reduce the risk of perineal tears.

3. Delay Pushing: Delaying pushing until you feel an urge to push can help reduce the risk of tears.

4. Controlled Birth: Having a slow and controlled birth of the baby's head and shoulders can help minimize perineal tears[^5^].

5. Water Births: Water births have been associated with a lower risk of perineal tears].

6. Hands-off Technique: Some evidence suggests that a hands-off technique during the delivery can help prevent perineal tears.

Read more
https://www.mother.ly/health-wellness/its-science/how-to-prevent-perineal-tears/
https://www.verywellhealth.com/the-perineum-2616422
https://scbp.ca/assets/documents/5_1_Perineal_massage_in_pregnancy.pdf