Everyone has a perineum. This tiny, sensitive region is located between the thighs and serves the function of separating the genitals from the anus. In males, the perineum is located behind the scrotum. In females, it’s located behind the vulva.

Perineum tears mostly affect those of us with vulvas, and as you can imagine, they’re rather unpleasant. There are essentially two ways to tear your perineum: delivering a baby and having sexual intercourse—the vaginal kind, of course.

Let’s talk about giving birth first.

Tearing Your Perineum While Giving Birth

Unfortunately, pushing something roughly the size of a pumpkin out of your vagina isn’t exactly easy on your body. The majority—upwards of 90 percent—of first-time mothers experience some form of tearing during childbirth. And the larger the baby, the more dire the consequences. Other factors, such as how long you push and whether the doctor has to yank your baby out with forceps, can also contribute.

Luckily, since you’ll already be giving birth, your doctor can address the tear on the spot. Mild to moderate perineum tears are typically treated with pain relievers and sometimes antibiotics, which prevent infection as the tear heals. Serious tears may require stitches.

Tearing Your Perineum During Sexual Intercourse

Having sex—the vaginal kind—can also cause a perineum tear. How does this happen? Well, vaginas are supposed to self-lubricate prior to sex. But, as those of us who have a vagina know, this doesn’t always happen. Whether your mind is simply elsewhere or you’re taking medication, there are a ton of things which can ultimately get in the way of vaginal … er … wetness.

The result? Sometimes, it’s a painful perineum tear. But when it comes to tearing, lubricant isn’t the only factor. In this case, size does matter—whether it’s an unusually large penis, a small vagina, an oddly shaped sex toy, or some combination of all of the above. Also: positions. Certain positions put more pressure on the wall of the vagina than others.

For the most part, lubing up can help you avoid a tear.

What To Do If You Tear Your Perineum

Minor perineum tears mostly heal on their own, without too much risk of infection or long-term effects. Going to the bathroom may hurt, but a stool softener can help with that.

You should avoid having sex so that the tear can heal. If you continue to have sex, the tear won’t be able to heal. Though you don’t always need to see a doctor for a small tear, you should see a medical professional if pain persists for more than one week.

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