Perineal pain

Perineal pain Editor Beth Shelly PT, DPT, WCS, BCB PMD Last Updated: June 2018

Current definitions

Perineal pain : the complaint of pain felt between the posterior fourchette (posterior lip of the introitus) and the anus (1) and in the male, between the scrotum and the anus (2).

Perineal pain syndrome is the occurrence of persistent or recurrent episodic perineal pain, which is either related to the micturition cycle or associated with symptoms suggestive of urinary tract or sexual dysfunction. There is no proven infection or other obvious pathology. Foot note: The ICS suggests that in men, the term prostatodynia (prostate-pain) should not be used as it leads to confusion between a single symptom and a syndrome. (2)

History

No other standard terms reports have included pain definitions. The EAU has classified pain syndromes with eight axis including system, end organ, referral and temporal characteristics, character, associated and psychological symptoms to allow for more complete description (3). The ICS Terminology for chronic pelvic pain syndromes lists perineal pain in two areas - with vulvar-vaginal pain and abdomino- pelvic pain. No formal definition is given in that text (4).

Controversies

The terms perineal pain is a symptom reported by the patient indicating the location of a sensation. This would include pain related to scar adhesion subsequent to surgical incisions (including episiotomy), fistulas, or skin lesions. Pain may be referred from nearby structures including hemorrhoids, vulvar skin, deep or superficial pelvic floor muscles, prostate, and others. It does not specify a mechanism and must be put together with signs and investigations to reach a diagnosis and ultimately a treatment plan.

Perineal pain syndrome implies a diagnosis but is still not specific to any one mechanism of pain. Careful examination and evaluation is needed to identify cause of pain and develop an appropriate treatment plan. It may be better to use more specific terms which can be linked to a proposed mechanism and treatment.

It is also important to use this term only when referring to the small localized area between the vagina or scrotum and anal opening as described above. Not to be confused with the broader "perineal region" or tissue of the pelvic outlet distal to the pelvic diaphragm.

References

  1. Haylen BT, de Ridder D, Freeman RM, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29: 4–20, 2010

  2. Abrams et al. Standardisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub-committee of the International Continence Society. Abrams P, Cardozo L, Fall M,

  3. Engeler D, et al Guidelines on chronic pelvic pain Eur Urol 2010;57(1):35-48

  4. Doggweiler, R. et al. A Standard for Terminology in Chronic Pelvic Pain Syndromes: A Report From the Chronic Pelvic Pain Working Group of the International Continence Society. Neurourology and Urodynamics 2016, DOI 10.1002/nau.23072.

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