The perineum is a small area of skin and tissue found between the anus and genitals (scrotum in most men, vaginal opening in most women). It protects your pelvic floor muscles, which support abdominal organs like the bladder. The perineum also protects nerves and blood vessels needed for urologic functions (like urination) and sexual function (like erections).

In most people, the perineum is about an inch and a half to two inches long — not a large area at all. But it is prone to injury, and it’s important to know how to protect it.

Some perineal injuries are acute, which means they happen suddenly. Others are chronic, which means they develop over time. They might also affect nearby organs, like the penis, scrotum, testicles, vulva, urethra, or rectum. 

Read on to learn more about perineal injuries.

Some perineal injuries are acute, which means they happen suddenly. Others are chronic, which means they develop over time.

How can the perineum be injured?

Perineal injuries can happen in a variety of ways:

• Childbirth. The perineum can tear during a vaginal delivery.
• Accidents. Your perineum could be injured when you’re playing sports or working at your job, especially if you work in construction or on a farm.
• Surgery. Sometimes the perineum is damaged during surgery, such as operations for colorectal and anal cancers.
• Weapons. Wounds from weapons or firearms can damage the perineum. Military personnel may sustain perineal injuries during combat.
• Sexual abuse. The perineum can be injured during rape or other forms of sexual violence.

What is a straddle injury?

A straddle injury is one type of perineal injury. It occurs when you land on something, such as a fence or a bicycle crossbar, with one leg on either side. In other words, your legs are straddling the item you land on, and the force injures the perineum.

Sometimes, straddle injuries develop over time from riding bikes, motorcycles, or horses.

What are the symptoms of a perineal injury?

If you have a perineal injury, you may have the following symptoms:

• Pain, especially in the abdomen, genitals, or groin
• Redness and swelling
• Bleeding
• Discharge from the vagina or urethra (the tube that urine flows out of)
• Difficulty with urination or moving your bowels
• Painful urination
• Blood blisters
• Open wounds
• Faintness
• Nausea or vomiting
• An embedded object

Some people experience erectile dysfunction (ED). This is the inability to get or keep an erection firm enough for sex.

If I think I have a perineal injury, what should I do?

If you think you have a perineal injury, get medical help as soon as possible, especially if you have an open wound, a fever, blood in your urine, or difficulty urinating. You may need to visit your local emergency department.

In some circumstances, such as sexual abuse, military combat, or weapons use, there might be an object embedded in the perineum. Examples may include a knife, bullet, or piece of machinery. If there is an object protruding from the wound, do not try to remove it yourself. This can cause more damage. A medical professional can remove it safely.

If you think the injury is related to sexual assault or abuse, do not change your clothes or bathe before you see a doctor.

How are perineal injuries diagnosed?

The doctor will start with a medical exam and ask you questions about how the injury happened. Be sure to share as many details as you can, as they will help your doctor work out a treatment plan.

You’ll likely have imaging tests, such as an X-ray, ultrasound, CT scan, or MRI.

How are perineal injuries treated?

Treatment for perineal injuries often depends on their cause. More serious injuries may require surgery to repair muscles and nerves. You may need a catheter to drain urine from your bladder while your body heals. (Learn how to take care of an indwelling catheter.)

Your doctor will tell you how to change any bandages or dressings. They may also prescribe medications to relieve pain or treat any infections. Some patients receive a tetanus shot. 

Once you are home, there are ways to relieve symptoms. Your doctor will recommend which are best for you. Some examples are:

• Cold packs or compresses. Applying a cold compress to the area a few times a day can help with pain and swelling.
• Sitz baths. During a sitz bath, you sit in shallow, warm water that covers your perineum. Some people take sitz baths in their own bathtub. You can also buy a kit that includes a basin to place over your open toilet. The warm water can relieve pain and discomfort.

What complications might I have?

Sometimes, perineal injuries lead to other problems, such as:

• Difficulty with urination and bladder control
• Infections
• Pelvic floor issues
• Sexual problems, like erectile dysfunction and priapism
• Development of scar tissue

How can I prevent perineal injuries?

Pay close attention to your environment and take extra care when working or playing sports. Always wear protective gear.

If you enjoy cycling, be sure to have your bike fitted by a professional. They can make sure the seat, handlebars, and pedals are adjusted for your body. Choose a wider, noseless bike seat to reduce the pressure on your perineum. Wearing padded shorts is another option.

You might also try standing at certain intervals while riding your bike. If you’re going on a long ride, be sure to take frequent breaks.

Resources



Cleveland Clinic



“Perineum”
(Last update: October 26, 2022)
https://my.clevelandclinic.org/health/body/24381-perineum

“Sitz Bath”
(Medically reviewed: September 11, 2022)
https://my.clevelandclinic.org/health/treatments/24137-sitz-bath

MedlinePlus

“Genital Injury”
(Last review: October 1, 2024)
https://medlineplus.gov/ency/article/000044.htm

National Institute of Diabetes and Digestive and Kidney Diseases

“Perineal Injury in Males”
(Last reviewed: April 2020)
https://www.niddk.nih.gov/health-information/urologic-diseases/perineal-injury-males

WebMD Ignite via UMass Memorial Health

“Understanding Straddle Injury”
(no date)
https://www.ummhealth.org/health-library/understanding-straddle-injury-0