The perineum sits quietly between the vulva and the anus.

Physically, it’s packed with nerves and soft tissue, which means it reacts quickly to friction, pressure, and movement. The perineum is part of the pelvic floor, and the pelvic floor has a habit of responding to life by tightening and contracting. If you’ve ever noticed yourself clenching when you’re uncomfortable or overwhelmed, your perineum was likely involved.

I’ve had plenty of moments where mine has flared up for various reasons, like a long walk, a workout, tight jeans, and a stressed-out week.

Most of us were never taught how to care for this area. We have routines for our faces, our hair, even our vulvas, but the perineum exists in a strange blind spot, despite being central to our pelvic stability and pleasure.

This article is a practical look at how to care for the perineum, with detailed steps and suggestions on how to nurture this part of the body.

 

Why the Perineum Is One of the First Places to React to Stress or Trauma

The perineum reacts to stress because it is directly controlled by the nervous system’s protective reflexes. When the brain senses stress, fear, or threat it activates the sympathetic nervous system, the same system responsible for the fight-or-flight response.

As part of this response, the body automatically tightens areas that protect vital openings. The pelvic floor contracts to close and support the bladder, bowel, and reproductive organs. Because the perineum forms the outer base of the pelvic floor, it tightens at the same time. This contraction happens before conscious thought as a reflex.

This response is designed to be short-lived. In a brief stressful moment, the muscles contract and then release. But when stress is ongoing the nervous system stays partially activated. The pelvic floor does not fully relax between stress signals, and the perineum remains slightly clenched throughout the day.

When the perineum stays contracted, two things happen. First, blood flow is reduced. Tissues heal and stay healthy through circulation, and reduced blood flow makes the area more sensitive and slower to recover. Second, constant contraction places tension on scar tissue and nerves, which can cause soreness or pulling sensations even without new injury.

 

How Childbirth Affects the Perineum

During vaginal birth, the perineum stretches significantly to allow the baby to pass through. This stretch affects the skin, muscles, connective tissue, blood vessels, and nerves in a very short amount of time. Even when birth goes well, this level of strain often leaves the tissue sore or injured.

I experienced a 1 cm second degree perineal tear during childbirth that required stitches. Although this type of tear is often described as minor, the healing process created scar tissue, which behaves differently from normal tissue.

Because of this, for me the area has remained quite tender long after birth. Skin healing happens first, but deeper tissue that consists of muscle, fascia, and nerves, takes more time to adapt.

 

Why Perineal Tears Happen

Perineal tears occur when the tissue cannot stretch quickly or fully enough to accommodate the baby’s head and shoulders. Factors such as baby size, speed of delivery, positioning, instrumental births, or previous trauma can all influence tearing.

Tears are commonly categorized by severity:

• Second-degree tears involve the skin and muscle of the perineum and often require stitches.
• Third- and fourth-degree tears extend deeper, involving the anal sphincter and, in the most severe cases, the tissue lining the rectum.

Symptoms You May Notice

Following childbirth—especially when perineal tearing is involved, it’s common to experience:

• Pain or tenderness in the perineum
• Swelling or a feeling of pressure
• Difficulty passing urine
• A strong or unpleasant-smelling discharge
• Sensitivity during sitting, walking, or intimacy

 

The Role of the Anal Sphincter

The perineum and the anal sphincter share muscle fibers, connective tissue, and nerve supply, and they work together to control bowel movements and maintain stability at the base of the pelvis. The external anal sphincter sits just behind the perineum and is part of the same muscular network that supports continence and pelvic floor coordination.

During childbirth, when the perineum stretches or tears, force is transmitted backward toward the anal sphincter. If a tear extends close to or into this muscle, the body often responds by increasing muscle tension in the area as a protective strategy. This can create ongoing tightness and discomfort in the back passage.

Even when the anal sphincter itself is not torn, the surrounding tissue may be strained or overstretched. Because bowel movements require coordinated relaxation and contraction of both the sphincter and the perineum, any disruption in this relationship can lead to difficulty fully relaxing.

 

Healing Timelines For Perineal Tears

Superficial perineal tears usually heal within a few weeks, particularly with rest and appropriate care. However, when tears involve deeper layers or are close to the anal sphincter, healing takes longer because muscle and nerve tissue adapt more slowly than skin.

True recovery requires restoring circulation, softening scar tissue, reestablishing normal nerve feedback, and rebuilding confidence in bowel and pelvic function. This process can take months and may fluctuate, with periods of improvement followed by temporary setbacks.

The goal is to restore function and comfort so the perineum and anal sphincter can work together again without strain.

 

Immediate Postpartum Care of the Perineum

1. Cleansing With Warm Water

In the early postpartum days, the perineum is tender and often healing from tears or stitches. Using warm water to cleanse the area is far gentler than wiping. A peri bottle or squirt bottle can be used while urinating to dilute urine and reduce stinging, while also rinsing away bacteria. Instead of toilet paper, gently pat the area dry or allow it to air dry to protect delicate healing tissue.

2. Cold Therapy for Swelling

Swelling and a heavy, pressured feeling are common after birth as blood flow increases to the perineum. Applying cold therapy can help soothe inflammation and numb discomfort. An ice pack wrapped in a soft cloth and placed against the area for short periods can bring relief, especially in the first few days postpartum.

3. Keeping the Area Clean and Dry

A clean, dry environment supports faster healing and reduces the risk of infection. Sanitary pads should be changed frequently, even when bleeding seems minimal, as moisture can irritate the skin and encourage bacterial growth. Free Bleeding during postpartum does wonders to speed up healing as it allowing air to reach the perineum. Choosing breathable fabrics and avoiding tight clothing also helps prevent friction and tenderness.

4. Supporting the Bowels and Bladder

The perineum is closely involved in both urination and bowel movements, and strain in these areas can slow healing or increase pain. Keeping stools soft can prevent unnecessary pressure on healing tissue. Taking time, avoiding pushing, and even supporting the perineum with a clean hand or cloth during bowel movements can reduce discomfort and protect stitches or scar tissue.

5. Warm Baths, Sitz Baths, and Natural Soothing

Warm baths or sitz baths help reduce lingering inflammation and promote tissue repair. They can be especially soothing for tender scars and discomfort during bowel movements. Warm water also invites the nervous system to relax, creating a sense of safety that allows deeper healing to take place.

 

Pelvic Floor Support as Part of Perineal Healing

The perineum is an integral part of the pelvic floor. It is part of a deeper system of muscles and connective tissue that span from the pubic bone to the tailbone and from sit bone to sit bone. Several pelvic floor muscles attach directly into the perineal body, which means any change in pelvic floor function directly impacts the perineum.

After childbirth, the pelvic floor often becomes lengthened and weakened. When these muscles lose strength or endurance, they provide less lift and support from below. This lack of support can place increased strain on the perineum, especially if there has been tearing or stitching.

Scar tissue in the perineum may feel sore or stretched because it is compensating for weakened muscles above it. Some women also develop a chronically tight or overactive pelvic floor after birth. This often occurs as a subconscious protective response to pain.

Both weakness and tightness disrupt the pelvic floor’s ability to respond. A healthy pelvic floor should be able to contract, relax, and lengthen as needed. When this coordination is lost, the perineum often becomes the site where symptoms show up first because it sits at the junction of these forces.

 

Holistic Tools to Support Perineal Healing

 

Yoni Steaming

Yoni steaming is a practice where warm steam that is often infused with herbs is directed toward the vulva and vaginal opening while sitting above a steaming pot or jar. Traditionally, it has been used as part of personal hygiene and perineal care.

For the perineum, yoni steaming works through warmth and moisture, two factors that scar tissue and sensitive tissue respond to particularly well. The heat increases blood flow to the muscles of the perineum and surrounding pelvic floor, improving circulation to tissue that may otherwise remain tight or dry. The warmth also encourages the muscles of the perineum to relax.

This practice is not to be used immediately after birth. Yoni steaming should only be introduced once all perineal wounds are fully closed and bleeding has resolved. At that stage, it can be used as part of ongoing perineal care and personal hygiene to support reintegration and comfort rather than acute healing.

When used at the right time and with appropriate guidance, yoni steaming offers a simple, non-invasive way to support the perineum’s return to softness and function.

Read: Yoni Steam While Pregnant: What’s Safe and What’s Not

 

Crystal Wands 

Crystal wands are smooth, shaped tools designed for gentle internal pelvic work. They are used externally and internally to apply light, sustained pressure to pelvic floor tissue, including areas close to the perineum. They help address tight or restricted tissue that has developed after tearing or prolonged muscle guarding.

After the perineum has healed, scar tissue can remain firm and less elastic than surrounding tissue. Scar tissue does not soften on its own and it requires gentle movement and pressure to restore flexibility and circulation.

When used slowly, with breath and adequate lubrication, crystal wands can be applied around the vaginal opening, along healed scar lines, and near the perineal body where the muscles of the perineum commonly hold residual tension.

This work is only appropriate once the perineum is fully healed. Crystal wands should not be used if there is active pain or unresolved inflammation.

Read: How to Use a Crystal Wand for Pelvic Floor Health & Relaxation

 

Yoni Eggs

Yoni eggs are small, weighted stones designed to be held inside the vagina to support pelvic floor rehabilitation. They help retrain the coordination between the pelvic floor muscles and the perineum once healing and tissue mobility have been restored.

Yoni eggs provide gentle feedback to the pelvic muscles, helping them relearn how to lift, relax, and respond appropriately rather than remain inactive or tense.

Many women with pelvic floor symptoms cannot feel whether the muscles are engaging or releasing. The presence of the egg helps bring awareness to the area, and in turn, you consciously build strength and control.

Yoni eggs should only be introduced once the perineum is fully healed. They are not appropriate if there is active pain or healing tissue.

 

Lifestyle Practices for Perineal Health

• Hydration
• Fiber-rich nutrition
• Sitz baths
• Warm baths
• Pelvic floor exercises
• Gentle walking
• Avoiding prolonged sitting
• Supportive seating or cushions
• Adequate rest and sleep
• Breathwork for pelvic relaxation
• Stress reduction practices
• Mindful bowel habits
• Gentle stretching
• Wearing breathable fabrics
• Proper hygiene
• Avoiding heavy lifting
• Using a peri bottle
• Regular pad changes
• Hands-on perineal support when needed
• Posture awareness

 

FAQ