Perinealgia

Perinealgia is a clinical term used to describe pain localized to the perineum, the area between the genitals and the anus in both men and women. The sensation can be sharp, burning, dull, or ache-like and may be constant or episodic. Symptoms often worsen with sitting, urination, bowel movements, coughing, or sexual activity, and may be accompanied by itching, numbness, or hypersensitivity in the perineal region.

Causes of perinealgia are diverse and often require careful evaluation. Neuropathic causes include pudendal neuralgia, a disorder in which the pudendal nerve is irritated or compressed. Pelvic floor myofascial pain, where trigger points in the pelvic muscles generate pain, is another common source. Infections such as prostatitis, urethritis, or pelvic inflammatory disease; inflammatory or dermatologic conditions of the perineum; and trauma from surgery, childbirth, or falls can also produce perineal pain. Chronic pelvic pain syndrome, irritable bowel syndrome, and radiation or oncologic scenarios are additional considerations. Rarely, perinealgia may reflect more serious conditions and warrants appropriate medical assessment.

Diagnosis relies on a detailed medical history and physical examination, including a focused pelvic or rectal exam. Diagnostic imaging (such as MRI of the pelvis or ultrasound) and laboratory tests help exclude other conditions. Nerve-related etiologies may be supported by responses to diagnostic nerve blocks (for example, pudendal nerve block) and sometimes by specialized tests like pelvic floor EMG.

Treatment is multidisciplinary and individualized. First-line approaches emphasize physical therapy focusing on the pelvic floor, biofeedback, heat or cold therapy, and lifestyle adjustments. Pharmacologic options include NSAIDs for pain, and neuropathic agents (such as gabapentin, pregabalin, or duloxetine). Injections (pudendal nerve blocks or botulinum toxin) and, in selected cases, surgical decompression of the pudendal nerve may be considered. Addressing underlying conditions and reducing aggravating factors, such as prolonged sitting or constipation, are important components. Prognosis varies; many cases improve with comprehensive therapy, while others persist as a chronic condition.