Perineal Massage
Perineal massage is one of the many tools in a pelvic floor PT’s toolbox. Perineal massage isn't a standalone fix for preventing tears. It's one piece of a larger pelvic floor program that's built around your specific body. Here's what it is and how I walk my patients through it once we've assessed their pelvic floor and confirmed it's the right fit for their pregnancy.
What is the perineum?
The perineum is the area of skin, connective tissue, and pelvic floor muscle between your vaginal opening and your anus. During vaginal birth, this tissue stretches significantly to let your baby descend through the birth canal. When that stretch happens quickly with no preparation, tearing is more likely.
Why bother?
Perineal massage during pregnancy has been shown to reduce tearing and reduce perineal pain, especially for first-time vaginal births.
In my clinical opinion, the benefit from perineal massage is not just from (or even mostly from!) stretching—despite what social media (and it’s new obsession with perineal massage) would have you think! With my clients, I am often using perineal massage to elicit a bit of discomfort in order to teach the birthing partner how to relax, perform diaphragmatic breathing, and avoid clenching up in the face of pain.
Frequency and timing depend on your body’s specific needs; including your current coordination, strength, and tension of your pelvic floor; your hip mobility; and so much else. I'll recommend a specific starting point and cadence based on your body and your pregnancy, but generally this starts somewhere between 34 and 36 weeks, performed anywhere from twice a week to every other day.
How I recommend doing it
This is the protocol I give patients after we've gone through an evaluation together and I've gotten a feel for their individual anatomy and any areas that need extra attention. Some general guidance out there has you hold each position for one to two minutes. That works too, but in my experience 45 seconds per position gets the same benefit without turning this into a chore you dread doing several times a week. Furthermore, holding for too long can actually dehydrate the tissues!
Positions: Work through the bottom half of the "clock," roughly 3 o'clock to 9 o'clock through 6 o'clock at the bottom. About 6 positions total.
Hold time: 45 seconds max per position, steady pressure rather than pushing for the most intense stretch you can tolerate.
Getting set up:
Clean hands, short nails, water-based lubricant or a plain oil like olive or grape seed.
Optional: a warm shower or compress beforehand increases blood flow and softens tissue.
Get into a relaxed position: propped up on pillows, leaning back against a headboard, or on the couch with one knee leaning against the back of the couch. A hand mirror can help if you're new to this.
Technique:
Insert your thumb (or your partner's index finger) about 3 to 4 cm into the vagina.
Press down and to the sides in a U shape.
Look for tingling or mild burning/discomfort, not pain. Pause, breathe, let the tissue soften, then move to the next position.
Work through all 6 positions, 45 seconds each.
If your partner is helping: have them stay superficial, no deeper than about 2.5 knuckles. That keeps the work focused on the perineal tissue itself.
Checkout this Youtube video if you’d like visual instruction: https://www.youtube.com/embed/YWtUdRdDeG4?si=OH7LDYeiABEVtjFd
Keep in mind
Skip it if you have a high-risk pregnancy, unless your provider has cleared you.
Skip it if you currently have a vaginal infection like thrush or herpes.
Some tightness at first is normal and eases with repetition.
Every pelvic floor is different, which is exactly why we look at yours together first and tailor this to what you actually need before you start doing it at home.
