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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
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