The perineum is the tiny patch of sensitive skin between the genitals (vaginal opening or scrotum) and anus, and it’s also the bottom region of the pelvic cavity. The perineum may refer to just the part of your body you can see (the skin in between your genitals and your anus). Some might refer the perineum as the perineal area, genital area, or the triangle area between the legs.

Perineal care (peri-care) is bathing the genitalia and surrounding area. Some clients may be embarrassed, but this is part of client care. It is important to maintain a professional, matter-of-fact attitude. As with all good caregiving efforts, remember to allow the client to do as much as they can on their own. You can start by providing the client with a wet washcloth, soap, and a towel and then instructing them to wash the perineal area. You may need to say it in simpler terms so they understand, such as, “I’ll give you a washcloth so you can wash between your legs or your private area.” Remind clients with uncircumcised penises to retract the foreskin to cleanse the penis.

Cleanliness of the genital area is an important part of everyone’s care, particularly if the client is having difficulty controlling bowel and bladder function. This procedure is part of personal hygiene care and must be done whenever the client is soiled or wet.

Perineal Care for a Client with a Vulva

This procedure should always be a part of A.M. care.

Table 4.4.1 Procedure: Perineal Care for a Client with a Vulva

STEP	ACTION	REASON
1.	With the client lying on their back, uncover the perineal area only.	Provides privacy and warmth.
2.	Put on gloves.	Medical asepsis to avoid contact with mucous membranes.
3.	Separate the labia and use a clean part of the washcloth for each stroke. Wash from urinary meatus down to perineum (from front to back) as many times as needed. Use a clean part of the washcloth for each stroke.	Asepsis: Wash from top to bottom and clean to dirty to prevent cross-contamination.
4.	Wash down the labia minora and majora. Far then near, top to bottom. Rinse all areas well, using a clean part of the cloth for each stroke.
5.	Wash across supra-pubic area (far to near). Wash groin, starting on the farthest side, including the upper and inner thigh (top to bottom). Rinse and dry all areas well.
6.	Turn the client on their side facing away from you.
7.	Wash and rinse buttocks.
8.	Wash anus using a “J stroke” action. Then rinse using a corner of the towel or a fresh washcloth.	Asepsis. Do not rinse or place the washcloth in the basin after washing the anal area.
9.	Dry buttocks then dry anus.
10.	Remove gloves.
11.	Wash hands or use hand sanitizer.

Perineal Care for a Client with a Penis

This procedure should always be a part of A.M. care.

Table 4.4.2 Procedure: Perineal Care for a Client with a Penis

STEP	ACTION	REASON
1.	With the client lying on their back, uncover the perineal area only.	Provides privacy and warmth
2.	Put on gloves.	Medical asepsis to avoid contact with mucous membranes.
3.	Draw back foreskin, if uncircumcised. Wash the head of the penis from the urinary meatus outward in a circular motion, using a clean part of the cloth for each stroke. Rinse well using the same method. Return the foreskin.	Principles of asepsis: wash from near to far and top to bottom to prevent cross-contamination.
4.	Wash shaft of penis from head of penis toward the body, using a clean part of the cloth for each stroke.	To prevent cross-contamination.
5.	Wash down the upper surface of the scrotum.
6.	Wash across supra-pubic area. Wash groin starting on farthest side, including upper and inner thigh. Rinse and dry all areas well.	Principles of asepsis: wash from near to far and top to bottom to prevent cross-contamination.
7.	Turn the client on their side facing away from you.
8.	Wash and rinse the buttocks.
9.	Wash the anus using a “J stroke” action. Then rinse using a corner of the towel or a fresh washcloth.	Asepsis. Do not rinse or place the washcloth in the basin after washing the anal area.
10.	Dry buttocks, then dry the anus.
11.	Remove gloves.
12.	Wash hands/use hand sanitizer.

Additional Notes and Adaptations for Perineal Care

If the client is very difficult to turn or finds it painful to turn, you can use an adaptation to personal hygiene care and perineal care.

After washing the face, axilla, and hands, you may then wash the perineal area. You then remove your gloves, change the wash water, and obtain a new washcloth and towel. Then position the client on their side (Sim’s position), wash their back, and then put on new gloves and wash the anal area. By doing hygiene care in this sequence, you reduce the number of times you must turn the client, but you are still following all the principles of asepsis.

If the client wears an incontinent brief, you can then put that on while the client is on their side. Fanfold one side of the brief and tuck it under the client. Check for correct placement of the brief. It should cover their buttocks and groin area. The top part of the brief will be about 2.5–7.5 cm (1–3 inches) above their buttocks. Roll the client to the other side. Let them know they will feel a “bump” from the brief as they roll over it. Ensure the bed rails are up. Move to the other side of the bed. Pull the other half of the brief from under the client. Assist the client back to the supine position (client is lying on their back). Pull the brief up between their legs. Peel tape from tabs and fold each side inward toward the front. Secure tape to the front of the brief.