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Perineum: its role for women and why it is important to strengthen it

The perineum has, in short, the function of supporting the pelvic organs and is also responsible for urinary and fecal continence, in addition to acting in sex and childbirth. For all these reasons, your health must be preserved or, in some cases, recovered through proper exercise. Learn more about the function of the perineum and learn about effective exercises to work this region.

what is the perineum

Aparecida Monteiro (CRM 52669660), a gynecologist with a master’s degree in maternal and child health, a member of the Rio de Janeiro Gynecology and Obstetrics Association, explains that the perineal region (perineum) is formed by a set of tissues (muscle, fascia and ligaments) , which is located in the lower part of the pelvis. “These structures are embedded in the bony framework of the pelvis. This relationship between tissues and insertion is critical for keeping the pelvic organs in their proper places, while also allowing for the proper functioning of these organs,” she says.

“It is often said that the perineum is shaped like a diamond. It comprises the external genital organs and the pelvic floor, being crossed anteriorly by the vagina and urethra and, later, by the rectum”, adds Aparecida.

The importance of the perineum for women

Aparecida explains that this set of structures must be intact so that important functions are performed: support of Organs pelvic organs, maintaining the anatomical support of the pelvic viscera; assist in defecation, contraction of the urethra and vagina, among other points.

The perineum plays an important role in sex. “Some muscles in the perineum are related to sexual function, in both sexes. There are muscles that promote the maintenance of clitoral erection, acting in orgasm. Others contract or relax the vagina, which is important for intercourse. The musculature must relax so that penetration occurs in a pleasant way”, explains Aparecida.

“Excessive contraction can cause pain in intercourse, often not allowing or hindering penetration of the penis into the vagina, or even touching the site itself. On the other hand, vaginal looseness can be a reason for reduced pleasure. The balance of muscle functions, as well as its integrity, are very important for the quality of sexual intercourse. In addition, this region is richly vascularized and innervated, the stimulus by contact may increase the sensation of pleasure; for all this, the integrity of the place makes a difference”, adds the gynecologist.

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The perineum is still closely related to pregnancy. “It is part of the path that the fetus takes to be born. During pregnancy, we observed a preparation of this region that undergoes changes due to the increase in vascularization and the change in the hormonal pattern, being clinically confirmed by the change in color and vulvar edema. These changes are normal during the gestational period and affect the muscles and ligaments. All for the fetus to pass through the region. The passage of the fetus through the vaginal canal may result in muscle trauma that can occur due to spontaneous lacerations, as well as those caused by episiotomy (medical intervention) when performed”, explains Aparecida.

In the postpartum period, adds the gynecologist, some women will benefit from conservative treatments to restore the function of the perineum and its anatomy.

the perineoplasty

Aparecida explains that the rupture or stretching of the structures that make up the perineum can cause prolapse (descending) of pelvic organs – uterus, bladder, rectum, vaginal wall. “A woman may or may not have symptoms, such as feeling a vaginal bulge or pelvic pressure sensation, or even urinary, intestinal or sexual symptoms,” she says.

The gynecologist clarifies that genetic and hereditary issues, in addition to being female, predispose to prolapse. In addition, pregnancy, vaginal delivery (especially of very large babies), muscle diseases, and excessive weight-bearing activities are causes of prolapse. Obesity, smoking, chronic cough accelerate the process; and increasing age and menopause intensify the situation.

The perineoplasty is then the surgery that aims at the correction and restoration of the anatomy, alleviating the symptoms and correcting functional alterations of Organs pelvic organs. It is indicated for those women with symptoms or whose conservative treatment has not been successful. “Both conservative and surgical treatment should be offered, and the treatment of asymptomatic women is not recommended”, highlights Aparecida.

“When there is a change in anatomy and/or perineal function, alternatives to surgical intervention should always be encouraged. Treatment must be individualized, always taking into account the woman’s expectations and her possibilities of committing to conservative treatment. It is important to identify possible associated factors to be corrected: obesity, smoking and treatment of intestinal constipation”, emphasizes Aparecida.

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Why and how to work the perineum

Aparecida comments that, with so many important functions, all women should be encouraged to strengthen the place. “In addition, the recognition of the muscle groups that act in sexual intercourse, urination and defecation only help women to increase their quality of life. Knowledge of the body brings greater awareness and mastery over sensations, pleasures and discomforts,” she says.

Kegel exercises, highlights Aparecida, consist of “squeezing and releasing” the perineal muscles. “Each contraction should be as vigorous as possible and last 3-5 seconds. The rest interval between each contraction should be 2 to 3 seconds. Usually 10 contractions are done, 2 or 3 times a day,” he says.

“The most used accessories for this purpose are the vaginal cones that can have different weights; Thai balls that train contraction and relaxation of the vagina and mini-vibrators can also be helpful in strengthening. Bodybuilding has activities aimed at strengthening the pelvic floor”, adds the gynecologist Aparecida.

“The habit of exercising the perineal musculature brings very positive results when practiced on a regular basis, since any musculature that is not used ends up weakening. Like any exercise, they must be practiced correctly and in the right dose, excess is also harmful”, reinforces Aparecida.

Juliana Sesso (CREF 063424 G/SP), owner of Spaço Vitaly, physical educator and doula, specialist in physical exercise for pregnant women, preparation for childbirth and postpartum, explains that 70% of the fibers of the perineum are resistance and 30% force. “With proper exercise, perineal health can be achieved, maintained or restored. Prevention is always the best option,” she says.

It is worth remembering that the muscles of the perineum contribute to natural childbirth, helping the baby to come out. “The perineum during pregnancy is heavily overloaded due to the weight of the baby, regardless of whether vaginal delivery or cesarean section occurs, and it must be well worked out so that delivery takes place naturally and to prevent possible lacerations”, explains Juliana.

“This musculature needs to be worked in a balanced way, performing exercises that act on contraction and relaxation. The perineum needs to be toned and, at the same time, have its fascias released so that this musculature stretches for the baby’s passage and contracts, facilitating its exit”, adds the physical educator and doula.

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Exercises

Perineal exercises can be performed before, during and after pregnancy, and should always be guided by a specialized professional who has knowledge of this region. Juliana cites examples of exercises that work the perineum below:

  1. Sitting contraction and relaxation: perform the contraction of the vagina and anus for a few seconds and relax all the muscles at the same time. Pay attention not to contract buttocks, thighs and not to hold your breath.
  2. Squatting contraction and relaxation: squatting with your back against the wall, contract and relax your perineum.
  3. Lying with ball between your knees: Lying with your knees bent and with a ball between your knees, squeeze the ball and release.
  4. Bridge: lying with knees bent, raise the hips contracting glutes.
  5. Activation with breathing: lying down with bent knees, inhale through the nose and exhale through the mouth making a “shhhhh” sound, closing ribs and activating the abdomen and perineum.
  6. Open squat: standing, legs apart with feet diagonally, perform a squat up to 90°; relax the perineum on the way down and contract on the way up.

It is worth emphasizing that, as simple as they may seem, the exercises should always be guided by a specialized professional after an evaluation.

“In my classes with pregnant women, we work on strengthening with voluntary contractions and relaxation, and involuntary through forced expiration during the exercises. I always recommend perineal massage and epi-no to complement the preparation for childbirth. In the postpartum program, we worked on strengthening 30% of the fibers with voluntary contraction exercises and tone, 70% of the fibers with involuntary contraction exercises with breathing, postural and LPF (Low Pressure Fitness) exercises. I always guide the exercises that should be done at home after the face-to-face monitoring because it is necessary to be careful, for example, with excess contraction”, comments Juliana.

Now you know the important function of the perineum for women. Also get to know the types of vagina to acquire more and more self-knowledge!

The information contained on this page is for informational purposes only. They do not replace the advice and follow-up of doctors, nutritionists, psychologists, physical education professionals and other specialists.

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