What is perineal massage?

Perineal massage is a technique that can be used during pregnancy to help to stretch the perineum. It may reduce your risk of tears or other perineal trauma during birth, especially with a first birth.

Perineal massage also helps to stretch the skin and prepare you for the sensations of burning, stinging and stretching, which can happen when the baby’s head is being born. You may find perineal massage gets easier with practice and that it becomes more comfortable after 2 to 3 weeks. It can be helpful to have a partner’s support, if you chose to.

It’s important to remember that you have the right to choose what is right for you and your body. Some people chose not to massage their perineum.

What is the perineum?

The perineum is the space between the opening of the vagina and the anus. Typically, the perineum is around 3.5 centimetres long. The perineum stretches during childbirth to allow for the baby to be born.

You may not think about your perineum unless it becomes uncomfortable, or during pregnancy and when preparing for birth.

When can I start perineal massage?

Massaging the perineum is your choice. If you decide you’d like to try perineal massage, your doctor or midwife can advise you on when to start. Most people can start perineal massage around week 34 or 35 of pregnancy. Massage the perineum at least once or twice per week, right up to when your baby is born. You or your partner can massage your perineum — this too is your choice. Each session can last up to 5 minutes.

The best time to massage your perineum is when you are relaxed and have time. At first it may feel uncomfortable, and you may not be sure you’re doing it the right way. However, with practice, you will become more familiar with your body and the feeling of massaging your perineum.

How might perineal massage help during birth?

Perineal massage helps to prepare the vaginal area for stretching and the pressure sensations that happen as the baby is born. It also helps to prepare the perineum during late pregnancy, and it may encourage elasticity and reduce the risk of tearing during childbirth.

Perineal massage and warm compresses during birth has also been shown to help decrease perineal tear and recover more quickly following their baby’s birth.

Perineal massage during pregnancy can lower your chance of needing an episiotomy (a surgical cut made in your perineum).

Read more about birth injury.

How do I do perineal massage?

You can do perineal massage when you’re lying down, seated, standing or in the shower. It is completely your choice. It can help to use a water-soluble vaginal lubricant or a natural oil such as sweet almond oil. Avoid using nut-based oil if you have known allergies. You can ask your midwife for advice, and try this process:

• Gently insert your thumbs or 1 to 2 fingers, reaching 3 to 5 cm into your vagina.
• Apply gentle pressure downwards (towards your anus) and to the side of the vagina.
• You may feel a burning sensation — this may lessen over time.
• Hold the stretch for up to 2 minutes at a time and then release.
• Each session should last no longer than 5 minutes.
• Do not massage if you have active genital herpes, bleeding or a vaginal infection such as thrush.

Tips on how to start perineal massage

Start each perineal massage by:

• going to the toilet and emptying your bladder
• washing your hands well
• finding a relaxing place where you can do the massage — it’s important you feel relaxed so you get the maximum benefits
• you can use a mirror to help see your perineum

It can also be helpful to:

• sit on the toilet or make yourself comfortable on your bed
• have a warm bath or shower
• use a warm compress on your perineum before you start

How often should I do perineal massage?

You should do perineal massage once or twice a week to be beneficial. Doing it more often than this is usually not recommended.

Can my partner help me with perineal massage?

If you and your partner feel comfortable, then it’s fine to ask for their support. Most people consider their partner’s involvement in perineal massage as positive. If your partner is helping you, make sure they:

• have clean hands
• use either their thumbs or 1to 2 index fingers inside the lower part of your vagina
• are guided by you and how you are feeling

Communicate clearly with your partner about how much pressure is comfortable for you — massage should not cause you too much discomfort or any pain.

When should I not do perineal massage?

Perineal massage is generally safe. However, you should not massage your perineum if you:

• are less than 34 weeks pregnant
• have a low-lying placenta (placenta praevia)
• have a short cervix
• are bleeding from the vagina
• have an infection, such as vaginal thrush or herpes,
• have severe blood pressure problems during your pregnancy

Tips before starting perineal massage:

• Always wash your hands thoroughly before perineal massage to prevent infection.
• Do not do perineal massage if you have an open cut or infection on your hands or fingers.
• If you have had previous perineal surgery or your waters have broken, speak with your maternity care provider before starting perineal massage.

Should I do any other exercises to prepare me for birth?

It is strongly recommended to stay active and exercise during pregnancy. During pregnancy, the pelvic floor muscles help to support the baby and need to be relaxed when the baby is born. Pregnancy hormones, extra weight and changes to the muscles and ligaments in the pelvis all cause strain, which can lead to weak pelvic floor muscles and incontinence.

Like any muscle in the body, pelvic floor muscles can be strengthened and trained with regular, targeted exercise. It can be helpful to see a physiotherapist or continence nurse during pregnancy to learn how to do pelvic floor exercises correctly.

It can also be useful to join a pregnancy exercise class, for example, yoga, Pilates or swimming.

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Resources and support

For more information about perineal massage during pregnancy, speak to your:

• doctor
• midwife
• obstetrician
• physiotherapist

Read the Royal Brisbane and Women’s Hospital brochure on Antenatal Perineal Massage – preparing your body for birth.

Download the Royal Women’s Hospital (Victoria) fact sheet on Practising perineal massage during your pregnancy for more tips.