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Perineum Pain (Perineal Pain)

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Facts about Perineum Pain (Perineal Pain)


  • The perineum is the area between the anus and the testicles in men and the anus and the vagina in women.
  • Perineum (Perineal) pain is a central symptom in muscle based pelvic pain conditions.
  • A large majority of our patients have pain in the perineum.
  • Perineum pain can be made worse by sitting or standing.
  • In a 2009 Stanford study of our work published in the Journal of Urology, it was documented that 79% of subjects complained of pain in the perineum.
  • In a 2009 published study in the Journal of Urology, we documented key abdominal and pelvic muscles that all refer pain to the perineum (rectus abdominus, adductor magnus, and coccygeus).

Symptoms associated with Perineum Pain

Some people with perineal pain (pain in the perineum) say that they don’t actually feel pain but some variation of discomfort, aching, burning, fullness, squeezing, tightness, sharp or dull sensation. Perineal pain is often exacerbated with sitting and is usually associated with other symptoms. Typical symptoms include one or more of the following:

  • Genital pain, anal and rectal pain, suprapubic (above pubic bone) pain, pain in bladder area, tail bone pain, groin pain, low back pain
  • Discomfort when sitting (often feels like a golf ball), post bowel movement pain
  • Urinary frequency, urgency, hesitancy, burning, frequent night time urination
  • Sexual pain including orgasm and post orgasm discomfort (often the next day)
  • Anxiety, depression, helplessness regarding symptoms

The understanding and definition of pelvic pain including the common symptoms of genital and perineal pain, as well as its causes, risk factors, diagnostic tests, the understanding of its complications and other relevant matters is currently in transition. The treatment, drugs, lifestyle issues and concepts about home treatment are also in transition. The Wise-Anderson Protocol has often been more effective in the treatment of genital and perineal pain than the conventional treatment of drugs and surgery.

Perineum pain is a central symptom in most muscle based pelvic pain conditions.

sitstandThe Wise-Anderson Protocol, also known as the Stanford Protocol, has been successful in treating genital and perineal pain (pain in the perineum) in selected women and men who suffer with muscle-based pelvic pain conditions.

Both genital and perineal pain typically has its origins in trigger points and areas of muscle restriction inside the pelvic floor. In our 2009 study published in the Journal of Urology, we identified anterior levator ani trigger points that refer genital pain in men. Various other trigger points refer pain to the genital area in men and women.

The perineum is the area located between the anus and the scrotum in the male and between the anus and the vulva (the labial opening to the vagina) in women. The major muscles of the pelvic floor all attach to the perineum and it is one of the most common areas of pain in men and women who suffer from various forms of pelvic pain. Perineal pain makes sitting difficult and is sometimes related to post bowel movement pain.

Because the perineum is so intimately connected to the muscles of the pelvic floor, this symptom tends to be the last to reduce in intensity or the last to be resolved when the Wise-Anderson Protocol is successful in helping patients who have pelvic pain.

Relieving Perineum Pain With The Wise-Anderson Protocol Developed At Stanford

  • Pain in the perineum is commonly the result of trigger points that form in muscles up inside the pelvis.
  • Trigger points are tight, exquisitely painful bands of muscle tissue that form within chronically tightened muscles.
  • These trigger points in the perineum can remain in place for years. Their pain can be felt in places relatively far away from them and their pain can be caused by contracted muscles far away from them.
  • Pain in the perineum, even when it lasts for years, can get better with proper treatment.
  • A major focus of the Wise-Anderson Protocol is helping to relieve pain in the perineum.
  • The Wise-Anderson Protocol trains patients to release perineum pain related trigger points and to relax the muscles related to perineum pain.
  • A detailed description of the Wise-Anderson Protocol treatment for perineal pain can be found in the sixth edition of A Headache in the Pelvis. Click Here to order A Headache in the Pelvis.

Adapted Excerpts From A Headache In The Pelvis On Perineum Pain

“Millions of men and women suffer from pelvic pain, discomfort, or dysfunction. These disorders, which can be called chronic pelvic pain syndromes (CPPS), usually include one or a number of symptoms including rectal, genital, perineal or abdominal discomfort or pain, increased discomfort or pain sitting down, discomfort or pain during or after sexual activity, and often urinary frequency, urgency and hesitancy. Historically, these conditions have been given many different names. As a result, they have been thought to have numerous causes.

In the majority of cases, doctors can find little or no physical basis for the symptoms and most or all tests usually come back normal. In this book, we will demonstrate that there is a simple physical basis for the symptoms and that the seemingly wide array and variability of the symptoms are simply idiosyncratic expressions of the same underlying problem in both men and women. A treatment protocol has been developed, called the Wise-Anderson Protocol. In this methodology, we no longer treat the symptoms; instead we treat what triggers those symptoms. Our approach substantially reduces or abates symptoms in a large majority of qualifying patients who often have symptoms of genital and perineal pain.”