Perineal massage

Perineal massage is a method of preparing the body for the birth of your baby.

What is my perineum?

Your perineum is the area between the vagina and anus.

How will perineal massage help during birth?

Research has shown that women in their first pregnancy who practice perineal massage have a 64 per cent lower risk of significant perineal tears and 21 per cent decreased chance of episiotomy³.

What does perineal massage aim to do?

• Increase awareness of your pelvic floor.
• Recognise and effectively respond to stretch sensations of the perineum.
• Working with the sensations of birthing your baby’s head.
• Assist in recovery during the postnatal period by decreasing perineal pain.

When and how often should I do perineal massage?

Antenatal perineal massage can begin from 34 weeks of pregnancy, practiced two or more times a week.
Aim for 10-minute sessions, or shorter more frequent sessions if longer sessions are painful.
It is common to initially experience a strong stretch or burning sensation, which should decrease with practice. If your partner is performing the massage for you, it is important to tell them how much pressure to apply without causing pain.
If you have any concerns regarding pain or performing perineal massage it is recommended that you discuss it with your physiotherapist or health professional.

What should I do before I start perineal massage?

• Empty your bladder.
• Wash your hands (do not use alcohol rub).
• Find a relaxing place to perform the massage e.g bathroom or bedroom).
• Position yourself comfortably. 
• If you are comfortable, use a mirror to become familiar with the vaginal opening and the perineum.
• A warm bath or warm compresses on the perineum for 10 minutes prior to the massage may help.

How do I do it?

• Apply lubricant on both your thumb/s or index finger/s and the perineum.
• Place the thumb/s or finger/s inside the vagina to a depth of three to five centimetres (around the second knuckle).
• From the vaginal opening press downward towards the rectum until a very slight burning, stinging, or tingling sensation is felt.
• The massage can be done in one direction at a time (i.e. from side to side, or the thumbs can be swept in opposite directions). Try different ways until you find what is most comfortable for you.
• Focus on belly breathing while trying to relax the pelvic floor muscles and allowing the tissues to stretch.
• The massage can be completed in different ways for your comfort (e.g. you may need to complete one direction at a time).

Caution: Avoid pressure at the top of the vaginal opening. Massage gently as forceful massage could cause bruising or swelling. Cease massage with any pain or discomfort.

When you should NOT do it?

You should not perform perineal massage in any of the following situations:

• Prior to 34 weeks of pregnancy unless guided by a healthcare professional.
• If you have placenta praevia (a low–lying placenta) or any other condition where there is bleeding from the vagina during the second half of pregnancy.
• If you are suffering from vaginal herpes, thrush or any other vaginal infection, as massage could spread the infection and worsen the condition.

What about pelvic floor exercises?

Pelvic floor exercises should be practised daily throughout pregnancy. This practice will help you to be able to activate as well as relax the muscles of the pelvic floor. The relaxation of the pelvic floor is exactly what you will do to assist in the birth of your baby.

Doing pelvic floor exercises in pregnancy has also been shown to reduce the length of labour and risks of severe perineal tearing. Pelvic floor exercises after birth will help you to re-tone your stretched muscles and tissues.
 

References

1. Adbelhakim, A, et al. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J (2020) Sept; 31(9):1735-1745.
2. Beckmann MM, Stock O. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Systematic Review (2013).
3. Image Credit: Cancer Research UK (2021). Cancer Research UK. [online] Cancer Research UK. Available at: cancerresearchuk.org.
4.  Jones LE, Marsden N. The application of antenatal perineal massage: a review of literature to determine instruction, dosage and technique. Journal Assoc Charter Physiotherapy Women’s Health (2008); 102: 8-11.
5. Mei-DanE, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. (2008) Jul; 10(7):499-502.
6. Perineal massage image adapted from: Perineal Massage with Confidence – detailed instructions/videos available at pelvicfloormechanics.com.
7. Queensland Maternity and Neonatal Clinical Guideline: Perineal Care, Queensland Government (2023).
8. Sobhgol S, Smith C, Dahlen H. The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis. Int Urogynaecol J (2020).
9. Weronika M, Weronika P, Kolomanska-Bogucka D, Mazur-Biali A. Antenatal perineal massage – risk of perineal injuries, pain, urinary incontinence and dyspareunia – a systematic review. J gynecol Obstet Hum Reprod (2023) Jul 4; 52(8):102627.

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