Perineal Care

Perineal care (peri-care) is the cleaning of the genital and anal areas. This is one of the most personal types of care a CNA provides and requires sensitivity, professionalism, and strict attention to infection control.

Importance of Perineal Care

Health Reasons:

• Prevents urinary tract infections (UTIs)
• Prevents skin breakdown and irritation
• Removes bacteria that cause infection
• Controls odor
• Promotes comfort

When Perineal Care Is Needed:

• After each episode of incontinence
• After using bedpan or urinal
• During daily bathing
• Before and after catheter care
• After childbirth (postpartum)

Key Principles

Infection Control:

• Always wash from front to back (clean to dirty)
• Use clean area of washcloth for each stroke
• Never go back to an area already washed
• Change water if it becomes soiled

Dignity and Privacy:

• Explain procedure before starting
• Expose only the area being cleaned
• Use matter-of-fact, professional approach
• Provide privacy (door closed, curtain drawn)
• Allow patient to do as much as possible

Gender Considerations:

• Some facilities allow patients to request same-gender caregiver
• If patient refuses care, notify nurse
• Always maintain professional demeanor
• Use proper anatomical terms

Female Perineal Care

Equipment:

• Wash basin with warm water (105°F or less)
• Washcloth or perineal wipes
• Towel
• Clean gloves
• Clean linens if needed
• Waterproof pad

Procedure:

1. Explain procedure and provide privacy
2. Position patient on back with knees bent and apart
3. Put on clean gloves
4. Place waterproof pad under buttocks
5. Wet washcloth with warm soapy water
6. Cleaning Order:
   • Labia majora (outer lips) - one stroke down each side
   • Labia minora (inner lips) - one stroke down each side
   • Center area (urethral and vaginal openings) - one stroke front to back
   • Use clean area of cloth for each stroke
7. Rinse the same way with clean water
8. Turn patient to side
9. Clean buttocks and anal area (front to back)
10. Dry thoroughly
11. Apply barrier cream if ordered
12. Remove gloves, perform hand hygiene

Male Perineal Care

Procedure:

1. Explain procedure and provide privacy
2. Position patient on back
3. Put on clean gloves
4. Place waterproof pad under buttocks
5. For Uncircumcised Males:
   • Gently retract foreskin
   • Clean tip of penis in circular motion from urinary opening outward
   • Clean shaft of penis
   • Return foreskin to normal position (very important!)
6. For Circumcised Males:
   • Clean tip of penis from urinary opening outward
   • Clean shaft of penis
7. Clean scrotum, lifting gently to clean underneath
8. Turn patient to side
9. Clean buttocks and anal area (front to back)
10. Dry thoroughly
11. Remove gloves, perform hand hygiene

Critical Points

For Uncircumcised Males:

ALWAYS return the foreskin to its normal position after cleaning.

Leaving the foreskin retracted can cause swelling and circulation problems (paraphimosis), a medical emergency.

For All Patients:

Signs to Report

Notify the nurse if you observe:

• Redness, swelling, or rash
• Unusual discharge (color, amount, odor)
• Open sores or lesions
• Complaints of burning or itching
• Foul odor despite cleaning
• Signs of infection (fever, cloudy urine)

Perineal Care for Catheterized Patients

Patients with urinary catheters require careful perineal care:

• Clean around catheter insertion site
• Clean catheter tubing (away from body)
• Never pull on catheter
• Report leakage, discoloration, or crusting
• Check that drainage bag is below bladder level