The perineum: Myths and realities!

The perineum is an essential part of the female body, often overlooked but of vital importance to overall health. In women, the perineum is put under greater strain than in men, due to specific anatomical features, pregnancy and menopause, which cause tissue and muscle deterioration. Understanding its role, taking care of it and rehabilitating it if necessary is crucial to women's health and well-being. To shed some light on the subject, we put our questions to Irene Cabeza & Marine Coluni, physiotherapists specializing in women's pelvic health.

Close up of a young woman holding a balloon to explain the diaphragm zones, core and pelvic floor. Pelvic floor exercises explained

What is the perineum and why is it important?
The perineum is a key area between the pubis and the coccyx. It is made up of muscles, ligaments and tissues that support the pelvic organs. It's a part of the body that's particularly stressed by women, especially during pregnancy and with the onset of menopause.

What are its functions?
The perineum is an essential muscular structure with multiple functions! First and foremost, it supports the pelvic organs, keeping the bladder, rectum and uterus in place, but that's not all. It also regulates the ability to urinate and defecate, enabling controlled retention and release. What's more, it's directly linked to sexual sensations and satisfaction in this intimate sphere.

During pregnancy, the perineum shows its capacity to adapt by supporting the additional weight of the fetus, and during childbirth, it extends to facilitate birth. Finally, it plays a role in maintaining good posture by collaborating with the abdominal and back muscles. In short, the perineum is a major functional element of our anatomy that deserves attention and care.

The perineum is a major functional element of our anatomy that deserves attention and care.

How can a woman tell if her perineum is healthy?
If you experience urine leakage during sport, when carrying your child, or when laughing, sneezing or coughing, it may be time to consult a specialist. The same applies if you find it hard to control your urge to go to the bathroom, or if you often feel a sudden urgency, especially triggered by cold or the sound of water. A feeling of heaviness in the lower abdomen is also an indicator that you need to pay attention to your perineum.

Pain during intercourse, urination or defecation, as well as in everyday life, should not be overlooked. If you have problems holding back gas or stool, or if you notice a decrease in sensation during intercourse or difficulty reaching orgasm, these signs could indicate weakness of the perineum. In all these cases, a doctor, urologist, gynaecologist or physiotherapist will be able to help you find suitable solutions.

Speaking of professionals, what are your tips for maintaining a healthy perineum?
Start by developing an awareness of your pelvic floor. Learn to feel these muscles, to contract and relax them, to better understand how they work. When lifting or exerting yourself, remember to engage your pelvic floor and abdominal muscles for support. Avoid constipation by eating a high-fiber diet, drinking enough water and getting a little exercise every day (walking, dancing, fitness, swimming...).

Finally, pay attention to the way you go to the bathroom. Adopt a position that respects your natural physiology, such as sitting with your knees higher than your hips and without forcing, simply listening to your body's natural needs. By following these steps, you are actively contributing to the health of your perineum.

Taking care of your perineum is an investment in your long-term health.

There are a lot of preconceived ideas about the perineum. Could you demystify some of them?

There is an age limit for rehabilitation, after which it is too late: FALSE
The urge to urinate in the shower is normal: FALSE
We all leak when we exercise, even more so after giving birth: FALSE
If I gave birth by caesarean section, I don't need rehabilitation: FALSE
I can push on my stomach to urinate or pass stool: FALSE
Urinary incontinence is common in women TRUE (1 in 5 women)
Urinary incontinence can be aggravated by certain medications: TRUE
Urinary incontinence is normal with aging: FALSE
It hurts during intercourse, this is normal, especially after giving birth : FALSE

To conclude, what message would you like to pass on to our Mothers (-to be)?
The perineum, often underestimated, is in fact a fundamental part of your anatomy, especially during motherhood. As a (future) mother, becoming aware of this area and its functions can make a significant difference to your experience of pregnancy, childbirth and post-partum recovery. Taking care of your perineum is an investment in your long-term health.

By understanding its role, you can anticipate and prevent common problems such as incontinence or prolapse, which could otherwise affect your life considerably.

And remember, it's never too late to start taking care of this crucial area. If you encounter any difficulties or have any questions, the assistance of a healthcare professional is invaluable. Perineum specialists can provide personalized advice and tailored treatments to ensure this vital part of your body receives the care it deserves.