Perineal Massage: Does It Actually Help?

Apr 9

Written By Ash .

Perineal massage is one of those things that people either swear by or avoid like the plague. If you’re in the latter camp, hear me out. It’s an evidence-based technique that can help prepare your perineum (the area between your vagina and anus) for birth by increasing flexibility and reducing the likelihood of tears. And if the idea makes you cringe, don’t worry, I’ll walk you through the why, the how, and the positions that make it easiest.

What Does the Evidence Say?

Some studies suggest that perineal massage in the last few weeks of pregnancy can reduce the need for an episiotomy and lower the risk of severe perineal tears, especially for first-time birthers. A Cochrane Review found that people who performed perineal massage from 34 weeks onward had a lower incidence of perineal trauma that required stitches. The benefits were most noticeable for first-time vaginal births but were still present in those who had given birth before. It may also reduce postpartum perineal pain, which is always a win. Check out this podcast episode from Evidence based birth: The Evidence on Prenatal Perineal Massage for Preventing Tears in Childbirth with Dr. Rebecca Dekker where they explore more studies on the topic!

When to Start and How Often?

Most recommendations suggest beginning at 34-35 weeks of pregnancy. Aim for about 3-4 times per week, for 5-10 minutes per session. The key is consistency, not perfection.

Positions to Try

There’s no one “right” way to do a perineal massage, so find what works best for you. Some comfortable positions include:

Reclined with knees bent – Lying back with pillows supporting you and knees bent can help you reach more easily.
Standing with one foot up – Similar to how you’d position yourself for inserting a menstrual cup or tampon.
Squatting – This can be tricky if flexibility is an issue, but it gives great access.
With a partner – If your partner is helping, you can recline with knees apart or sit with legs open in a supported position.

Step-by-Step Guide to Perineal Massage

If you’re flying solo or having a partner assist, follow these steps:

Wash your hands – Basic but important.
Use a lubricant – Natural oils like coconut, olive, or a perineal massage oil work well. Avoid anything scented or irritating.
Find a comfortable position – Choose one from the list above.
Insert thumbs or fingers – About 1-1.5 inches into the vaginal opening.
Apply gentle pressure downward – Toward the rectum, stretching until you feel a slight burning or tingling sensation (but not pain).
Use a “U” motion – Gently massage along the lower vaginal walls in a sweeping “U” shape, holding pressure for about 30-60 seconds in each spot.
Breathe and relax – Deep breaths help release tension.
Repeat for 5-10 minutes – The goal is to gradually increase flexibility over time, not to overstretch in one session.

Using Tools for Perineal Massage

If reaching is tricky or you just prefer an alternative to using your hands, there are tools designed to help with perineal massage. Some options include:

Perineal Massage Wands – Made from body-safe silicone, these tools help reach the perineum with gentle, controlled pressure.
Massage Balls or Dilators – These can be used in a similar way to apply gentle pressure and increase flexibility.

When using a tool, apply a small amount of lubricant, follow the same general steps as manual massage, and go slow. The goal is comfort and consistency, not force.

Alternative Methods for Perineal Preparation

If perineal massage isn’t your thing, or you want to add more tools to your toolkit, here are some other ways to prepare your perineum for labor:

Warm Compresses During Labor – Applying a warm, moist compress to the perineum while pushing can increase blood flow and reduce the risk of severe tearing.
Perineal Support from a Birth Provider – Hands-on techniques from a midwife or OB can slow the baby’s descent and reduce tearing.
Upright or Side-Lying Positions for Pushing – Avoiding a flat-on-the-back position can relieve perineal pressure.
Slow, Controlled Pushing – Techniques like “blowing out the candle” breathing can help prevent fast crowning, which reduces perineal trauma.
Perineal Oils and Moisturization – Keeping the perineum supple during pregnancy with oils like vitamin E or coconut oil may help with elasticity.
Pelvic Floor Relaxation and Therapy – Learning to release and relax your pelvic floor muscles is a major part of preparing for birth. Many folks spend a lot of time strengthening these muscles but don’t realize that tight, overworked muscles can actually lead to more issues during labor. Consider working with a pelvic floor therapist, especially someone local like Trailhead Physical Therapy or PeaceAble Pelvis, to build awareness, release tension, and prepare your pelvic floor for the work of birth.
Perineal massage isn’t a magic bullet, but it’s a simple, research-backed way to help prepare your body for birth. Whether you try it alone, with a partner, or with a tool, just remember that any effort you put in can make a difference when the big day arrives. If it works for you, great! If not, there are plenty of other ways to support your perineum, like warm compresses and optimal pushing techniques.

Ash .