Perineal massage is a gentle stretching technique that may help prepare the tissues around the vaginal opening for childbirth. While research findings are mixed, some studies suggest it may lower the risk of tearing and other birth-related injuries when practiced regularly during the final weeks of pregnancy.
Here's why perineal massage may be useful — along with some step-by-step directions for how to do it.
What is a perineal massage?
Perineal massage is gentle, manual stretching of your pelvic floor to prepare the muscles and skin between your vagina and rectum for the birth of your baby. The goal is to reduce the risk of tearing and scarring when you deliver.
Your vagina is designed to stretch and accommodate your baby during childbirth and return to nearly its pre-pregnancy size within just a few weeks after delivery. Your perineum — or the pelvic floor tissues between your vagina and rectum — is less elastic and can tear as you give birth.
"I 100% see the value in it," says What to Expect Community mom muffin8744. "By the time I was done with my first session I could tell the area was already relaxed."
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What are the benefits of perineal massage?
While the benefits of perineal massage haven't been conclusively proven, it may:
- Reduce the risk of vaginal and perineal tearing
- Reduce the risk of episiotomy
- Prevent scarring
- Reduce postpartum pain associated with tears and trauma
- Lower the risk of postpartum urinary incontinence and fecal incontinence
Perineal massage may be especially helpful if this is your first vaginal birth or if you have a very tight pelvic floor and have experienced pelvic pain.
No studies have shown that perineal massage reduces pain during vaginal birth.
"I did it last time and it definitely worked!" says Community mom hannahanhuth. "I had some minor tearing on both sides, but not on the perineum. It was crazy to see the progress I made in how far it could stretch! Planning on doing it again this time for sure!"
Are there downsides to perineal massage?
There are several potential downsides to perineal massage:
- It might not work.
- It takes time and persistence. To experience any potential benefits, you'll need to do perineal massage regularly for the last four to six weeks of pregnancy.
- Massaging too aggressively can increase blood flow to an area that's already engorged with blood, potentially leading to irritation, inflammation, discomfort, or pain.
Talk to your practitioner before attempting perineal massage if you have a yeast infection, herpes, or any other vaginal infection.
If perineal massage causes even moderate pain, stop and ask your practitioner whether it might be a good idea to check in with a pelvic floor physical therapist.
How do you do a perineal massage?
Starting at around 34 weeks of pregnancy, take the following steps to try perineal massage at home:
- Wash your hands thoroughly and be sure your nails are clipped.
- Sit in a relaxed position with your head supported, your knees bent, and your legs spread apart.
- Apply a couple of drops of coconut oil, olive oil, or any other vaginal-safe lubricant to your thumb and perineum. (Avoid mineral oil and petroleum jelly.)
- Insert your thumb into your vagina up to about your first knuckle. You'll be massaging your perineum, not your entire vaginal wall.
- Apply gently pressure downward toward your rectum.
- Maintain the pressure as you move your thumb from left to right in a U-shape motion (from about 3 to 9 o'clock on an imaginary clock face).
- You should feel stretching and perhaps a bit of mild stinging or burning, but never pain.
- Continue massaging for three to five minutes.
- Repeat once or twice a week (and up to once a day) until delivery.
Having trouble getting around your belly? Your partner can lend a helping hand by following the same steps. "My husband does this for me. There's no way I could reach!" says Community mom littlegoldenlove16.
It may be worth scheduling a visit with a pelvic floor physical therapist. They can demonstrate the technique a couple of months before your due date. Some insurance companies may cover this kind of physical therapy, though out-of-pocket costs vary.
"My biggest friend in this process is a pelvic floor physio," says Community member minikima. "If you can get to one, they will do a session on you, so you know how it is supposed to feel. They also very much welcome partners to teach them how to do it!"
If perineal massage seems too awkward or time-consuming, it's okay to skip it. Your vagina and perineum were designed to stretch and accommodate your baby during childbirth.
Should you continue doing perineal massage after childbirth?
No, you should not (and probably won't want to!) continue perineal massage after you give birth.
However, once you feel ready, you can try a few gentle pelvic floor contractions, called Kegels, to reconnect with those muscles and check whether you can feel your vaginal wall contract. Practicing Kegels regularly may help increase healing blood flow to the area and reduce the risk of incontinence, but don't overdo it.
It's also a good idea to ask your practitioner to refer you to a pelvic floor physical therapist four to six weeks after delivery. A PT can check your pelvic floor and recommend exercises to help you heal — especially if you have pelvic floor dysfunction, pain, or incontinence.
You don't have to suffer. A little help from a person who specializes in pelvic floor rehabilitation can go a long way.
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