Perineal Growths: Causes, Symptoms, and Treatment Options

A protruding lump in the perineal area... has been a concern for several years. :(

Hello Doctor, I have had sexual intercourse, have never given birth, and have mild hemorrhoids with frequent constipation.
Due to my job, I often sit for long periods and have irregular sleep patterns.
Four years ago, I developed a long, flat growth in the perineal area that matches the surrounding skin color (without any redness, whiteness, or grayness) and is not painful.
Subsequently, I began experiencing blood in my stool.
At that time, I followed my boyfriend's advice and visited a gynecologist, but the doctor did not provide any specific information, so I didn't pay much attention to it.
Later, based on my mother's experience with hemorrhoids, I assumed it was hemorrhoids and consulted a colorectal surgeon.
The doctor confirmed the presence of hemorrhoids but stated they were not severe.
However, after looking at pictures of hemorrhoids online, I felt that my condition looked different (hemorrhoids are typically round and localized, while mine is more elongated, flat, and wrinkled, located along the entire perineal area).
A few days ago, I came across some discussions among pregnant women online, mentioning that during childbirth, the perineum may tear and heal, resulting in a growth that is not painful.
Although there were no pictures, the descriptions of the shape and location seemed similar to mine.

1.
I would like to ask, what could be the reason for the growth in my perineal area? What possible conditions could it indicate? Is there a way to eliminate it?
Another small issue: after my visit to the colorectal surgeon, the doctor performed a rectal examination, and I noticed some bleeding afterward.
I initially thought it was due to the anal dilation, but when I used a rectal suppository at home, I discovered that the blood was coming from my vagina.
My next menstrual period is expected in two weeks, but I am unsure why there is vaginal bleeding.

2.
Is it normal to have vaginal bleeding after a rectal examination?

Ms. Chen, 20~29 year old female. Ask Date: 2021/05/14

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
Having a photo would be helpful for making a diagnosis; it could be a polyp, wart, or tumor, and a physician's examination is necessary for proper assessment.
2.
Rectal bleeding is likely caused by different factors than vaginal bleeding, unless it is due to a fistula or cancer.
It is advisable to consult a gynecologist for an examination to alleviate any concerns.

Reply Date: 2021/05/14

More Info

Understanding perineal growths can be complex, especially when considering the various potential causes, symptoms, and treatment options. Based on your description, it seems you have developed a growth in the perineal area, which has raised some concerns, particularly in relation to your history of hemorrhoids and recent bleeding.

1. Possible Causes of Perineal Growths: The growth you describe as a "thin, flat piece of flesh" that matches the surrounding skin color could be several things. Common possibilities include:
- Skin Tags: These are benign growths that can occur in areas of friction, such as the perineum, especially in individuals who experience obesity or have conditions that cause skin irritation.

- Hemorrhoids: While you mentioned that a doctor diagnosed you with hemorrhoids, it's important to note that they can sometimes present in atypical forms. External hemorrhoids can appear as lumps around the anal area, while internal hemorrhoids may not be visible externally.

- Perianal Warts: Caused by the human papillomavirus (HPV), these can appear as small, flesh-colored or gray growths and can be mistaken for other conditions.

- Other Conditions: Less commonly, conditions such as anal fissures, cysts, or even benign tumors could present similarly.

2. Symptoms and Concerns: The fact that the growth is not painful and matches the skin color is reassuring, but the presence of blood in your stool and from the vaginal area is concerning. Blood in the stool can indicate several issues, including hemorrhoids, anal fissures, or more serious conditions like colorectal polyps or cancer. The bleeding from the vagina after a rectal examination could be due to several factors, including:
- Trauma: The examination may have caused minor trauma to the vaginal walls, leading to bleeding.

- Hormonal Changes: If you are near your menstrual cycle, hormonal fluctuations can sometimes cause unexpected bleeding.

- Other Gynecological Issues: Conditions such as cervical polyps, infections, or other abnormalities could also cause bleeding.

3. Treatment Options:
- For skin tags or benign growths, treatment is often not necessary unless they become bothersome. If removal is desired, it can typically be done in a doctor's office.

- For hemorrhoids, treatments can include dietary changes (increasing fiber intake), topical treatments, and in some cases, surgical options if they are severe.

- If the growth is determined to be a wart or another type of lesion, treatment options may include topical treatments, cryotherapy, or surgical removal.

4. Next Steps: Given your symptoms, particularly the bleeding, it is crucial to follow up with a healthcare provider. A thorough examination, possibly including imaging or a biopsy, may be necessary to determine the exact nature of the growth and the cause of the bleeding. It is essential to communicate all your symptoms clearly to your doctor, including the nature of the bleeding and any changes in your bowel habits.

In conclusion, while some perineal growths can be benign and not cause significant issues, the presence of bleeding warrants further investigation. It is advisable to seek a second opinion if you feel your concerns have not been adequately addressed. Regular check-ups and open communication with your healthcare provider are essential for maintaining your health and addressing any concerns promptly.

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