9 Reasons for Pain ‘Down There’: When to Call Your Doctor

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Does it hurt down there? Unpleasant sensations in your bottom area (between your anus and vagina) is called perineal pain. The organs in this area include the bladder, uterus, and rectum (the area at the end of the large intestine as well as nerves leading to these organs.

It’s not uncommon to feel pain in your perineum. Injuries, urinary tract issues, infections, and other conditions can cause perineum pain.


Read on to learn more about the potential causes and how to identify them.

1. UTIs (infections of the urinary system)

Pelvic pain is frequently observed in women with UTIs, either of the bladder, urethra, or kidneys. In this case, the pelvic pain may be accompanied by a persistent need to urinate, a feeling of burning during the process, and/or a strong smell and unusual color of the urine. The pain is usually characterized as dull.


2. Cystitis (painful bladder syndrome is a dysfunction of the pelvic nerves)

This is a long-lasting condition that can cause varying levels of pain and pressure in your bladder and pelvis. It’s caused by dysfunction to your pelvic nerves.

Instead of signaling you only when your bladder is full, they signal you throughout the day and night. This can result in perineum pain for some people.

If cystitis is the cause of your perineal pain, you may observe additional symptoms:

3. Injuries (sport accidents, falls, or delivering a baby)

Injuries of the groin can cause bruising, bleeding, and even tears in the perineum. This can lead to throbbing and intense long-lasting pain, or damage to the nerves and blood vessels in the perineum, which can cause bladder issues or problems during sex.

Common causes of perineum injuries include:

4. Pelvic floor dysfunction (a disease of the pelvic muscles that help your bowel movements and support your rectum, bladder, and uterus).

Pelvic floor dysfunction happens when the group of muscles that support the organs in your pelvis don’t contract and relax the way they usually do. Experts aren’t completely sure about the reasons for this, but it’s likely related to conditions or injuries that weaken your pelvic muscles or cause tears in connective tissue. These can include childbirth and pelvic surgery, and traumatic injuries to the pelvic area.


Other potential symptoms of pelvic floor dysfunction include:

5. Abscess (a pimple-like bump caused by an infection)

An abscess can occur anywhere when bacteria enter your body and cause an infection. Your immune system sends white blood cells to the area, which can cause pus to form in the area.

You can develop an abscess directly on the perineum or on a nearby area, such as the vulva. An anal abscess can also cause pain in the perineum. These are usually the result of an infection of your internal anal glands.

Other symptoms of an abscess include:

6. Pudendal neuralgia (an irritation of the pudendal nerve located in the perineum)

The pudendal nerve is one of the primary nerves of your pelvis. It travels to your perineum, rectum, lower buttocks, and genitalia. Pudendal nerve entrapment is a type of nerve damage. It happens when surrounding tissue or muscle starts to compress the nerve.

This type of compression may happen after an injury, such as a broken pelvic bone, surgery, or a tumor of some kind. It can also happen after childbirth.

The primary symptom of pudendal nerve entrapment is ongoing pain somewhere in your pelvic region, including your perineum, vulva, or rectum.

This type of nerve pain can be the following:

You might also feel numbness in the area or it may feel like an object, such as a golf ball, is stuck in your perineum.


7. Myofascial pain occurs because of the pelvic muscle spasms. It is often difficult to establish whether this is the primary problem or is a natural response to the presence of pelvic tenderness arising from another condition such as endometriosis. Spasms of the levators certainly contribute to additional distressing symptoms such as urinary retention, constipation, and dyspareunia.


8. Vulvodynia (chronic aching of the vulva) is chronic pain of the vulva, which is the external tissue around the opening of the vagina. It’s usually diagnosed if your doctor can’t find any other potential cause of your pain.

Its main symptom is pain in your genital area, including your perineum. This pain might be constant or come and go. In other cases, it might only occur when the area is irritated.

Other sensations you might feel in your perineum or genitals include the following:

9. Childbirth

During a vaginal delivery, you may need an episiotomy. This is a surgical incision in your perineum that enlarges your vaginal opening, making it easier for the baby to exit the birth canal.

The perineum can also tear during the birthing process. If your doctor thinks your perineum might tear during the process, they may decide to perform an episiotomy. This incision usually heals better than a tear does.

As you heal, you may have perineum pain. This tear or incision can also become infected. Contact your doctor right away if you’ve recently given birth and notice any of the following symptoms in your perineum:

Perineal pain can vary in severity: it can be severe or mild, or just felt as subtle discomfort.

As you can see, there are many possible causes for pain in the perineum. If your pain is long-lasting, severe, or causing you discomfort, contact your doctor.





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