The perineum, this great forgotten sport and health

The perineum, everyone has heard of it at least once but without really knowing, basically, what it is for. « It’s true, he has a bit of a ‘black box’ side, even for those who have done rehabilitationdeplores Patrick Papazian, sexologist doctor at the Pitié-Salpêtrière hospital, who summarizes his function It’s super simple: it fights against gravity! Over 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 fault at the bottom, at the level of the pelvis and the small pelvis, on the level known as the reservoirs. Our poor perineum therefore struggles against gravity on the floor of our pelvic floor. » From this derive certain important functions of continence, urinary as well as anal, visceral support and sexuality. In both women and men.

At the 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 specialized physiotherapist who demystifies it on her Instagram account @Princesseperinee. To understand its importance, there is no need to go into morphological details. We will content ourselves with retaining that this zone « goes from the front to the back, from the pubis to the coccyx, with muscles that cling 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 hold back 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 is this muscle we are talking about, the one that we can (in part) tighten voluntarily. “You must have the feeling that this area closes and rises from the anus to the pubis. This is a very important aspect: you have to go up and above all not down with a feeling of pushing.”, says Sabrina Fajau. Remember, it’s all about resisting gravity! « We must stop pushing, slouching and work on self-development »insists Dr. Bernadette de Gasquet, author of several books integrating the perineum.

©Carole Barraud for Les Echos Week-End

On a daily basis, this means adopting a few good habits: “Perform 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 when going to the saddle and avoid abdominal exercises that bring the shoulders together of the pelvis because it increases the pressure on the viscera”, list Bernadette de Gasquet. For Sabrina Fajau, the best recipe is still to move. « The slogan ‘movement is your best medicine’ also applies to the perineum »she says, recalling that no sport is harmful as long as it is not practiced excessively (more than 8 hours per week). “Moving gives him life, gives him flexibility and competence. »

Beware of overtraining!

Please note, “competent” does not mean “concrete” either. It is sometimes the mistake of the beginner who discovers his perineum and frantically puts it to work. “It’s often presented as a hammock, but it’s more useful to imagine it as a trampoline. If the canvas is not taut enough, there is not enough support, but if it is too taut, it is as if the organs are banging against a wall”image Sabrina Fajau, who sees as many patients with a perineum that is too tight or too distended. “Hypertonic, it can lead to pain and difficulty in sexuality, for women as well as for men. It can also lead to too rapid ejaculation.adds Patrick Papazian.

This is why Sabrina Fajau likes to remind you that a perineum “Which is fine, it’s a perineum that we don’t take care of on a daily basis. He’s supposed to do his job on his own. » No need to overdo it! In practice, this area can be undermined by our overly sedentary lifestyles and certain stages such as pregnancy, childbirth or menopause, and for men, hypertrophy or removal of the prostate. “He is a bit of the big forgotten in the education of the body. There is a lot of work to be done with people before problems arise. Otherwise we arrive after the battle, which is a real shame, especially during prolapse [descente d’organes, NDLR] always a bit traumatic”believes Patrick Papazian.

Warning signs, solutions

It is therefore as important to leave his perineum alone when he is well as to identify the signs of a potential problem in order to react without delay. Clearly, alert to the occurrence of urinary or anal incontinence, gas, feelings of heaviness in the lower abdomen, discomfort or pain during or outside sexual intercourse, lists Sabrina Fajau. “There should be no taboos, there are health professionals whose job it is to treat this area: urologists, specialized physiotherapists, proctologists and gynecologists. »

Many autonomous perineal rehabilitation tools, for example via a probe connected to an application, have been developed in recent years. « It’s fun and interesting, but you have to make sure you have had at least one consultation with a health professional beforehand (midwife, physiotherapist, etc.) to make a real assessment »judge Patrick Papazian.

Vital for a fulfilling sexuality

Apart from 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 beings of flesh and blood and that it also happens in the small pelvis and the muscles of this area », recalls Patrick Papazian. The most important perineal muscle bears the evocative name of “bulbo-cavernosus”. Intervening in the erection of the penis and the clitoris, it is located at the root of the penis and the vaginal vestibule. “We can educate him to learn how to delay ejaculation a little, even if it’s not all up to him. To feel it, men can put their fingers between the scrotum and the anus and try to contract this area with the help of feedback from touch.explains the sexologist doctor.

In women, “The bulbo-cavernosus is the constrictor muscle of the vagina, the guardian of the temple in a way, on which we can play to have better vaginal tone. It also makes it possible to understand that the vagina is not a passive and receptive organ: its shape changes according to the excitement and it is just as toned as a penis”. he continues. The deep muscular plane of the perineum, apart from the restraint muscle, remains difficult to contract voluntarily but is mobilized reflexively during an orgasm. This is why Bernadette de Gasquet likes to recall that “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).

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