SummaryPrimary perineal hernia is rare and may be mistaken for other diseases of the perineum and adjacent organs. It most often presents as a mass at the inferior margin of the gluteus maximus muscle. Reduction into the pelvis identifies the defect in the levator ani or coccygeus muscles. Discomfort with sitting is a common complaint. Most authors have preferred to repair primary perineal hernias through an abdominal incision.