Perineal Massage

Your vagina is designed to stretch and accommodate your baby during childbirth and return to nearly the same size within just a few weeks after delivery. Your perineum — or the pelvic floor tissues between your vagina and rectum — is slightly less elastic and can tear as you give birth.

Since your baby’s head needs to squeeze through a relatively small opening, you may be wondering if there’s any way you can prepare yourself down there for childbirth. If you’re willing to put in a bit of work in the weeks before delivery, perineal massage just might help get your pelvic floor ready for birth.

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.

Does perineal massage really help with labor pain and delivery?

Some evidence suggests that doing perineal massage during the last month of pregnancy can reduce the risk of vaginal and perineal tears and episiotomy. But there haven’t been many studies, and the findings are inconclusive. Still, even though it’s not sure to help, there's no evidence that it will make things worse — and many women swear that it helps.

No studies have shown that perineal massage reduces pain during vaginal birth.

How do you do a perineal massage?

It’s not always easy to figure out how to give yourself a perineal massage, so it’s a good idea to schedule one visit with a pelvic floor physical therapist. He or she can show you the ropes a couple of months before your due date. Some insurance companies may cover this kind of physical therapy, but the cost to you will vary depending on your plan.

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 on a bed with your legs bent and your knees spread wide.
• Apply a couple of drops of coconut oil, olive oil or any other lubricant designed for the vagina (just avoid mineral oil or Vaseline) to your thumb and perineum.
• Insert your thumb into your vagina up to about your first knuckle. (You’ll just be massaging your perineum, not your full vaginal wall.)
• Apply gently pressure in your vagina downwards, toward your rectum.
• Maintain the pressure as you move your thumb from left to right in a U shape (from about 3 to 9 o’clock, if you imagine a watch).
• You should feel a stretch and a bit of 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 a hard time making your way around down there? Your partner can lend a helping hand by following the same steps.

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 when the time comes.

Benefits of perineal massage

While the benefits of perineal massage still haven’t been proven through scientific studies, it may:

• Reduce the risk of perineal tearing and damage
• Reduce the risk of episiotomy
• Prevent scarring
• Reduce postpartum pain associated with tears and trauma
• Reduce the risk of postpartum urinary incontinence and fecal incontinence

Perineal massage may be more helpful if this is your first vaginal delivery and might be especially beneficial if you have a very tight pelvic floor and have experienced pelvic pain.

Downsides of perineal massage

There are a number of potential downsides of perineal massage:

• It might not work.
• It takes time and persistence. To experience any of the potential benefits, you should do perineal massage regularly for the last four to six weeks of pregnancy.
• Massaging too hard can boost blood flow to an area that’s already engorged with blood, which can increase inflammation and lead to irritation, discomfort and pain.

Talk to your practitioner before attempting perineal massage if you have a yeast infection, herpes or any other vaginal infection.

If perineal pain causes even moderate pain, stop and ask your practitioner whether it might be a good idea to check in with a physical therapist.

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.

You should, however, try a few gentle pelvic floor contractions called Kegels as soon as you feel ready after delivery, to check in and see if you can feel your vaginal wall contract. Don’t overdo it, but keep up Kegels regularly to increase healing blood flow to the area and decrease the risk of incontinence.

It’s also a good idea to ask your doctor about referring you to a physical therapist four to six weeks after delivery, who 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!