Hello,

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The inflamed perineum could be due to a number of causes. Termed as anusitis - this could arise from infections such as Shigella, salmonella, or from IBD (Inflammatory Bowel Disease )

The swelling description matches with Haemorrhoids, BUT haemorrhoids will not have surrounding perennial inflammation and symptoms. So it could be a coexisting haemorrhoids. Another possibility is a infected cyst or abscess. (Less likely as they are not very much tender). Steroid injections can also cause inflammation.

A single diagnosis at this stage would be difficult. A step by step approach is needed. For now you can apply Preparation H OTC (1% Hydrocortisone cream). This will take care of the inflammation (regardless of the cause). Do not use for more than a week. Take high fibre diet. DO NOT strain while passing stool. DO NOT use strong soaps or irritants. Clean with water only.

This should take care of the symptoms. Beyond a week the symptoms you will need a physical examination (per rectal examination ) and some baseline tests.

I would like to know where there is a recent history of any high risk sexual exposure. Also do you have any abdominal symptoms such as bloating, pain, diarrhoea etc.

Hope this helps
Feel free to ask followups
Thank you