The Importance of the Perineum in Childbirth

The perineum is the surface area between the pubis symphysis and coccyx. In females, this is the small flesh between the vagina and the anus. It has a thin layer of fibromuscular subcutaneous tissue and skin with less hair than the rest of the genitals.

Throughout most of your life, you probably will not give your perineum a second thought. However, during pregnancy, your perineum will take on a greater significance as you prepare for childbirth.

Perinium, illustration
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Preventing Perineal Tears

During childbirth, the perineum stretches tremendously to allow for the mother to push the baby out. Sometimes this results in a perineal tear, which can be difficult to stitch back up and heal.

You are at greater risk for tearing during your first vaginal birth if you are having a large baby, if you gained substantial weight during pregnancy, or you are either younger or older.

During pregnancy, you can work on stretching the perineum and preventing tearing through regular perineum massages. Also known as birth canal widening, perineum stretching can be done at home during the final weeks leading up to your due date.

The goal is to learn to relax your pelvic floor muscles and stretch the vaginal opening. Your obstetrician or midwife can show you how to give a perineal massage.

What an Episiotomy Is

To prevent perineal tearing, your doctor may perform an episiotomy. An episiotomy is an incision in the perineum to make the opening larger for childbirth. Once the baby's head is seen, the doctor or midwife will ease the head and chin out.

If the opening isn't large enough, the healthcare provider will perform an episiotomy. If you have not already had an epidural or other anesthetics, the doctor will first numb the area.

Then during the pushing stage of labor, the obstetrician will use surgical scissors or a scalpel to make a quick incision in the perineum. Once the placenta is delivered, the doctor will check for any additional tearing before stitching up the area with dissolvable sutures.

Healing After Childbirth

Following childbirth, it is common to have pain in the perineum, whether you have had an episiotomy or not. An ice pack may help to reduce pain and swelling.

Your doctor may also recommend sitz baths to ease soreness and speed healing, along with medicated creams or numbing spray.

Over-the-counter pain relievers may also help, but be sure to check with your doctor about which ones he or she recommends.

If you have had an episiotomy, try to keep the incision clean and dry, as recommended by your doctor. This is especially important after urinating and bowel movements.

Your doctor may also limit your activity following an episiotomy. Be sure to follow your doctor’s instructions exactly. You should also not douche, use tampons or have sex until your obstetrician clears you. Be sure to keep your postpartum checkup to ensure your perineum is healing correctly.

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Article Sources
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  1. Goh R, Goh D, Ellepola H. Perineal tears - A review. Aust J Gen Pract. 2018;47(1-2):35-38. doi:10.31128/AFP-09-17-4333

  2. Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;2:CD000081. doi:10.1002/14651858.CD000081.pub3

  3. Frohlich J, Kettle C. Perineal care. BMJ Clin Evid. 2015;2015

Additional Reading
  • Episiotomy. Johns Hopkins Medicine Health Library website.