1. Pregnancy
  2. Giving birth
  3. Labor and delivery

Flo Fact-Checking Standards

Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles.

Perineal Massage: Everything You Need to Know

Naturally, you may be slightly concerned about vaginal tearing during delivery. The good news? Perineal massage could decrease the likelihood of this occurring by gently stretching your perineum. Read on to learn more about the advantages of perineal massage.

Your perineum is the pelvic floor muscle located between your pubic symphysis (in the front), coccyx (in the back), and thighs. In other words, it’s a rhombus-shaped area between your legs, beginning above the clitoris and ending just past the anus.

The region between your vagina and anus is more aptly named the perineal body. During a vaginal delivery, all the muscles in your pelvic floor work together to stretch and contract. This allows your baby to pass through the birth canal. 

As their head comes through the vaginal opening, your muscles must be able to stretch far enough to push their shoulders and body through. Your perineum represents your child’s final gateway to the world.

Roughly 79 percent of women will experience some tearing as a result of vaginal delivery. Still, the majority of cases aren’t severe (affecting only perineal skin and the epithelium of your vagina), and should heal on their own. Not surprisingly, first-time moms have a greater chance for sustaining vaginal tears. 

Medical professionals categorize vaginal and perineal tears by degree of severity: 

  • First-degree tears tend to be most common, impacting the skin on the surface of your perineum (closest to the vaginal opening). They usually heal on their own within a few weeks of childbirth. 
  • Second-degree tears may require stitches as they affect more than just the skin. They go beyond the surface of your vagina to the perineal muscles, but not the anal muscles. 
  • Third-degree tears affect your perineum as well as the muscles around your anus and require surgery. 
  • Fourth-degree tears are the most severe, but the least common (happening in less than 2 percent of cases). Generally requiring reconstructive surgery, they impact your perineum, anus, and rectum. Note that surgery and specialized treatment means a longer recovery time

Since the perineum plays a crucial role in delivery, experts recommend perineum massage for pregnant women in the weeks leading up to their due date. Perineal massage relaxes your muscles and increases flexibility prior to childbirth.

Certain cultures have practiced perineal massage for hundreds, if not thousands of years. The ultimate goal of perineal massage is to minimize pain and reduce your chances of tearing.

Perineal massage enhances your awareness of sensations in and around your perineum, preparing you for what’s to come.

Perineal massage involves manually stretching and massaging the muscles of your perineum from the skin’s surface to the vaginal opening. Additionally, perineal massage enhances your awareness of sensations in and around your perineum, preparing you for what’s to come.

The physical and emotional benefits of perineal massage are numerous. Aside from preventing tearing, perineum massage also potentially eliminates the need for an episiotomy. This procedure manually cuts the perineum if it doesn’t stretch enough for your baby’s head to pass through.

Aside from preventing tearing, perineum massage also potentially eliminates the need for an episiotomy.

Women who practice perineum massage prior to delivery report less vaginal pain in the weeks after. Furthermore, they felt more emotionally prepared for childbirth and less overwhelmed by sensations like burning or stinging than those who didn’t do perineal massage.

Experts suggest beginning perineal massage in weeks 34 or 35. Regular perineal massage (for at least four weeks) decreases the need for an episiotomy by nearly 15 percent in first-time moms. In some cases, your health care provider may perform perineal massage during labor and delivery to prevent tearing. 

Perineal massage can actually be done on your own or with the help of a partner. After consulting your doctor or midwife, give these perineal massage exercises a try:

  • Wash your hands thoroughly before doing a perineal massage.
  • From a comfortable, seated position, spread your legs apart with your knees bent and locate the perineum with your fingers. If you’re doing the massage on your own, use a mirror for better visibility.
  • Apply a small amount of lubricant to your fingertips or thumb and insert it 2 inches (5 centimeters) into your vagina. 
  • Gently press the right side of your vaginal wall towards the right and hold pressure there for a few breaths. 
  • Slowly sweep and press downward, holding pressure down towards your rectum. Then sweep and press over to the left. Trace and retrace this ‘U’ shape a few times in each direction.
  • As you become more accustomed to this, you can press downwards and stretch the vaginal walls apart at the same time. (You’ll need two hands for this!) Hold for 2 to 3 minutes.

Remember to start with a gentle touch and gradually increase pressure over time. Breathe deeply and slowly throughout the perineal massage to keep your muscles relaxed. Apply enough pressure that you feel a slight burning, stinging, or tingling, but never intense pain.

Perineal massage can actually be done on your own or with the help of a partner.

Ideally, perineum massage should be done one or two times a week for four weeks to be effective. Some even recommend perineal massage three to four times a week (at least 5 minutes per session). Speak with your doctor to determine the appropriate frequency of perineal massage for your pregnancy.

You shouldn’t do perineal massage earlier than the 34th week of pregnancy. What’s more, perineum massage is not recommended if you have placenta previa or vaginal bleeding in your second and third trimesters. If you have herpes or other vaginal infections, please exercise caution with perineal massage as it could cause them to spread.

Perineal massage is an easy and effective way for you to prepare your body for vaginal delivery and reduce your chances of tearing. Be sure to consult your doctor or midwife to find out if perineal massage is right for you.

https://www.healthlinkbc.ca/health-topics/tn10339

https://www.mayoclinic.org/episiotomy/img-20006450

https://www.rcog.org.uk/en/patients/tears/reducing-risk/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403252/

https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129?s=4

https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/care-during-labour-2nd-stage/who-recommendation-techniques-preventing-perineal-trauma-during-labour

https://www.cochrane.org/CD006672/PREG_perineal-techniques-during-second-stage-labour-reducing-perineal-
trauma

https://www.ouh.nhs.uk/patient-guide/leaflets/files/12101Ptear.pdf

https://www.healthlinkbc.ca/health-topics/tn10339

http://brochures.mater.org.au/brochures/mater-mothers-hospital/perineal-massage

https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tn10339

Read this next