The perineum, this great forgotten sport and health

The perineum, everyone has heard of it at least once, but without really knowing what it is for. “It’s true, he has a bit of a ‘black box’ side, even for those who are rehabilitating.”regrets Patrick Papazian, doctor sexologist at the hospital of Pitié-Salpêtrière, summarizing his function It’s super simple: it fights gravity! In the course of evolution we have become more vertical and if our organs are more or less on top of each other, there is still a huge flaw at the bottom, at the level of the pelvis and pelvis, at the level known as the reservoirs. Our poor perineum therefore struggles against gravity at the bottom of our pelvic floor. † From this arise certain important functions of continence, both urinary and anal, visceral support and sexuality. In both women and men.

At an anatomical level, the perineum is not easy to describe. It is not a muscle but a group of muscles and even “an area made up of muscles, soft tissues (tendons, ligaments, etc.) and organs”, explains Sabrina Fajau, a specialist physiotherapist who demystifies it on her Instagram account @Princesseperinee. To understand its importance, it is not necessary to go into morphological details. We will be satisfied with the preservation that this zone “goes from front to back, from the pubic bone to the coccyx, with muscles clinging to the different bony structures and that there are three muscle planes – superficial, medium and deep – because it takes at least that to fight against gravity! » laughs Patrick Papazian.

Good daily habits

If you really want to keep a muscle, let’s mention the biggest of the set, the relatively self-explanatory name levator ani. When we ask to “contract the perineum”, it’s this muscle we’re talking about, the one that we can (partially) voluntarily tighten. “You should feel this area closing and rising from the anus to the pubic bone. That is a very important aspect: you have to go up and especially not down with a feeling of pushing.”, says Sabrina Fajau. Remember, it’s all about resisting gravity! “We need to stop pushing, slouching and working on self-development”insists Dr. Bernadette de Gasquet, author of several books that integrate the perineum.

©Carole Barraud for Les Echos Week-End

On a daily basis, this means learning a few good habits: “Do efforts such as lifting, pushing and pulling on exhalation after contraction of the perineum (as if to hold back an urge), position yourself well and do not push as you go to the saddle and avoid abdominal exercises that lift the shoulders of the pelvis because it increases the pressure on the intestines”, list Bernadette de Gasquet. For Sabrina Fajau, the best recipe is still to move. “The slogan ‘exercise is your best medicine’ also applies to the perineum”she says, recalling that no sport is harmful as long as it is not over-exercised (more than 8 hours a week). “Movement gives him life, gives him flexibility and competence. †

Beware of overtraining!

Note, “competent” does not mean “concrete” either. It is sometimes the novice’s fault who discovers his perineum and frantically sets it to work. “It is often presented as a hammock, but it is more convenient to imagine it as a trampoline. If the canvas isn’t tight enough, there isn’t enough support, but if it’s too tight, it’s like the organs banging against a wall.”image Sabrina Fajau, who sees an equal number of patients with a perineum that is too tight or too swollen. “Hypertonic, it can lead to pain and problems in sexuality for both women and men. It can also lead to too fast ejaculation.adds Patrick Papazian.

This is why Sabrina Fajau likes to remind you that a perineum “That’s fine, it’s a perineum that we don’t take care of on a daily basis. He has to do his job alone.” No need to exaggerate! In practice, this area can be undermined by our too sedentary lifestyle and certain stages such as pregnancy, childbirth or menopause, and for men, hypertrophy or removal of the prostate. “He’s kind of forgotten the big one in body education. There is a lot of work to be done before problems arise. Otherwise we will arrive after the battle which is very unfortunate especially during a prolapse [descente d’organes, NDLR] always a bit traumatic”says Patrick Papazian.

Warning Signs, Solutions

It is therefore just as important to leave his perineum alone when he is healthy, as it is to recognize the signs of a potential problem in order to respond as quickly as possible. Clearly alert to the occurrence of urinary or anal incontinence, gas, a feeling of heaviness in the lower abdomen, discomfort or pain during or outside intercourse, Sabrina Fajau lists. “There should be no taboos, there are health professionals who treat this area: urologists, specialist physiotherapists, proctologists and gynaecologists. †

In recent years, many autonomous perineal rehabilitation aids have been developed, for example via a probe linked to an application. “It’s fun and interesting, but you have to make sure you’ve had at least one consultation with a healthcare professional (obstetrician, physiotherapist, etc.) beforehand to get a real estimate”Judge Patrick Papazian.

Essential for a satisfying sexuality

In addition to continence and visceral support, our perineum plays another role and not the least: it participates in our sexual development. “A lot of things happen in the brain in this regard, but let’s not forget that we are also flesh-and-blood creatures and it also happens in the small pelvis and muscles of this area”, recalls Patrick Papazian. The main perineal muscle bears the evocative name “bulbo-cavernosus”. It intervenes in the erection of the penis and clitoris and is located at the root of the penis and the vaginal vestibule. “We can teach him how to delay ejaculation a little bit, even if it’s not all up to him. To feel it, men can put their fingers between the scrotum and anus and try to contract this area using feedback of touch.explains the sexologist.

in women, “The bulbo-cavernosus is the constrictor muscle of the vagina, in a sense the guardian of the temple, on which we can play to get a better vaginal tone. It also makes it possible to understand that the vagina is not passive and receptive organ is: the shape changes with the arousal and it is as tight as a penis”. he continues. The deep muscle plane of the perineum, apart from the fixing muscle, remains difficult to contract voluntarily, but is reflexively mobilized during orgasm. That’s why Bernadette de Gasquet likes to remember “the best perineal rehabilitation is to have orgasms”. In this Patrick Papazian joins her. “Sexual activity, alone or with a partner, remains the best way to mobilize your perineum! †

small library

● Sabrina Fajau, “In Perinée we trust” (first editions, 2021).

● Bernadette de Gasquet, “Perineum, Let’s Stop the Massacre” (Marabout, 2020) and “The unsuspected power of sheathing” (with Teddy Riner, Marabout, 2021).

● Patrick Papazian, “Prostate” (with Edouard Klein, Opportun, 2018) and “Pamper your vagina” (with Caroline Michel, Larousse, 2019).