What Perineal Massage Actually Does — & How To Get Started

Photographed by Ashley Armitage.
As you prepare to give birth, you might take a childbirth class, practice patterned breathing, and pack a hospital bag. You might also consider starting to massage your perineum — the area of skin between your vaginal opening and anus. 
Perineal tearing is common during labor: according to the American College of Obstetricians and Gynecologists (ACOG), 53-79% of vaginal deliveries will involve some type of laceration. Although the majority of these are not severe, it’s understandable to want to avoid tearing if possible, and to reduce the severity of tearing if it’s not possible to avoid it entirely.
Perineal massage has been shown to help do just that. According to the ACOG, it "can decrease muscular resistance and reduce the likelihood of laceration" when practiced during either the end of pregnancy or during labor. The American Pregnancy Association recommends that people spend five minutes per day on perineal massage during the last 3-4 weeks of pregnancy, though different doctors and midwives may have slightly different recommendations (for example, massaging for ten minutes twice a week instead of five minutes a day). 

What is perineal massage? 

To put it simply, perineal massage is massaging the perineum. You can do this yourself, or your partner can do it for you. The massage helps stretch and relax your perineal tissue prior to childbirth

What are the benefits of perineal massage?

Studies show that perineal massage helps reduce the risk and severity of tearing during childbirth, particularly for people giving birth for the first time. It also helps reduce the risk of postpartum perineal pain. Some doctors also recommend perineal massage in the months after giving birth, to help alleviate discomfort. 

Does perineal massage work?

Studies differ on how much, exactly, perineal massage reduces the risk of tearing, but tend to agree that it does help some, particularly for people giving birth for the first time. The American Academy Of Family Physicians gives perineal massage a B-strength recommendation, meaning that evidence is inconsistent or limited-quality.
An AAFP-published review found that perineal massage decreased the likelihood of having an episiotomy for women who had never given birth before, and that regardless of whether they’d given birth before, women who practiced perineal massage were less likely to report postpartum perineal pain. 

How to do a perineal massage

Before beginning a perineal massage, wash your hands! Then, the American Pregnancy Association suggests finding a comfortable position in which you can reach your perineum, for example, sitting in bed with your knees bent, squatting against a wall or on a stool, or standing with one leg up on a stool, chair, or the toilet. If a partner is massaging you, you can sit facing them with your legs draped over theirs. 
Next, pour about a teaspoon of perineal massage gel on your fingers and apply it to the perineum. Then, insert your thumbs or fingers about an inch inside the vagina, pressing down gently towards the anus and then pulling your fingers apart and out to the sides. Hold this position and relax your muscles a few times during the massage. You’ll feel pressure, and you may also feel some stretching or burning during the first week or two. Continue for about five minutes, reapplying gel as needed and changing position if you get uncomfortable.
Remember, different healthcare professionals may have different recommendations on the details, so check with yours before you begin. 

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