Perineal Massage: Is it Worth it?

Peri-what? 

The perineum is the area in between your vagina and your anus. This tissue makes up the back part of your birth canal and is vital for pelvic floor strength but also needs to be flexible enough to stretch during childbirth. 

And you massage it?

Yep. Perineal massage involves gentle stretching of the perineum with your fingers. It is an ancient practice and there is strong evidence indicating when done regularly, between weeks 34 and 36 of pregnancy, it will increase your chances of a vaginal delivery in addition to reducing your risk of tearing and episiotomies (a surgical incision along your perineum usually performed during the second stage of labor to help get baby out). 

Research indicates perineal massage is most supportive for first time moms but I still recommend it for veteran moms as well. Your birthing provider can also perform perineal massage for you during birth to help reduce your risk of tearing or episiotomies.

I’m listening…

Because tears and episiotomies often require stitches, this can lengthen your recovery time and increase likelihood of symptoms like scarring, pain, and urinary or fecal incontinence. And because perineal massage can lower your risk of tearing, we’re all for it. But, we do recognize small tears are VERY common. The goal is to avoid the bigger tears that tend to come with more complications. This practice can be as short as 2 minutes at a time, but yields months if not years of benefit.

If you do experience some tearing, you can actually use perineal massage postpartum to help heal your tear and prevent excessive scar tissue or adhesions from forming. Seeking help from a pelvic floor physical therapist will also do wonders for your recovery. 

When should it be avoided?

• Before 34 weeks 

• If you have placenta praevia (a low–lying placenta) or any condition with vaginal bleeding during the second half of pregnancy

• If you have vaginal herpes, thrush or any other vaginal infection

Prep time

1. Empty your bladder

2. Wash your hands and make sure your nails are trimmed 

3. Find your relaxation haven (somewhere you feel most comfortable and can be in a position where your pelvic floor is relaxed).

4. Grab a mirror the first few times to familiarize yourself 

5. Pro tip: a warm bath or compress on the perineum for 10 minutes prior to massage helps tissues to relax 

All hands on deck 

1. Assume a comfortable position where you can access your perineum from the front (i.e. reaching from the front of your body, propped up in bed with your knees bent) or the back (reaching from behind, standing with one leg on edge of tub or toilet). We encourage you to try a different position each time or even within the massage if you get uncomfortable or tired. 

2. Put about a teaspoon of an organic oil (ex: coconut oil, vitamin E oil, etc.) or an unscented lubricant designed for the vagina between your fingers and apply liberally to your fingers and the tissues of your perineum. Keep your lubricant of choice on hand, you may need to reapply during the massage to ensure you are keeping your tissues adequately wet. 

3. You may use thumbs or fingers from one or both hands. We advise starting with both thumbs but you may switch it up if this doesn’t feel right for you. 

4. Insert thumb or finger of choice into your vagina about an inch (up to first knuckle or just past) while resting palms on the inside of your leg

5. Start with a gentle pressure that you can increase as you go. Press thumbs/fingers downwards towards the rectum and then pull them apart from each other and out towards the sides. Keep massaging down and out in a “U” motion to relax these tissues 

6. Several times during massage, hold this stretched position while consciously relaxing your muscles. It’s helpful to practice your breathing while doing this. 

7. It’s normal to feel a slight burning or stretching sensation, especially the first few weeks. But it does not have to be painful. If so, try easing off pressure or massaging in a different position. 

8. Continue (reapplying lubricant as needed) for 5-10 minutes - you can slowly work up to this amount of time as you gain comfort. 

*You may also try this with your partner: sit facing your partner with your legs draped outside your partner's legs. They can follow the steps above but with their index fingers instead of thumbs. Just make sure to voice how much pressure you need without pain. 

Dosage:

It’s most effective if you practice daily, but don’t sweat it if you miss a day or two. Just simply pick up your routine the next day. This may feel awkward or uncomfortable the first few times, but if you keep at it, you’ll find it gets much more comfortable.