Perineal massage is a technique used during the final weeks of pregnancy to gently stretch the tissues between the vaginal opening and anus (the perineum) in preparation for childbirth. When performed correctly, it may help improve the flexibility of the perineal tissues, reduce the likelihood of significant tearing during a vaginal delivery, and help you become more familiar with the sensations of stretching before labor.
In this guide, you’ll learn when to start perineal massage, how to perform it safely, and when working with a pelvic floor physical therapist may be beneficial.
Perineal massage and pelvic floor massage are distinct techniques focusing on the pelvic region. Perineal massage targets the perineum, the area between the vagina and anus in women, or between the scrotum and anus in men.
It aims to enhance flexibility and elasticity in preparation for childbirth, potentially reducing the risk of tearing or the need for an episiotomy. This technique is commonly recommended for pregnant women in the weeks leading up to delivery.
On the other hand, pelvic floor massage concentrates on the pelvic floor muscles supporting pelvic organs. It serves various purposes such as alleviating tension, improving muscle tone, addressing pelvic pain, incontinence, or pelvic floor dysfunction, and aiding in postnatal or post-surgery recovery.
While perineal massage focuses on childbirth preparation, pelvic floor therapy has broader therapeutic applications and can be performed by professionals or through self-massage techniques at home.
HOW TO PERFORM PERINEAL MASSAGE
Most people choose to begin around 32-34 weeks of pregnancy.
We do not recommend this practice if you are on pelvic rest restrictions or at risk of preterm labor.
Supplies:
Your preferred lubricant or natural oil (e.g. coconut oil, extra virgin olive oil)
Towel for clean up
Get comfortable:
Empty your bladder if you need to. There is no need to go “just in case.”
Lay in a supported, reclined position with knees in a “butterfly” shape. Use pillows to support you and help you fully relax.
Perineal Massage Technique:
Most people are unable to reach their vagina at this point in the pregnancy. A partner will probably be helpful! If you’re able to reach by yourself, use your thumb. A partner should use their index finger.
Imagine the vaginal opening as a clock: 12:00 is towards the pubic bone and 6:00 is towards the anus.
Insert a lubricated finger into the vaginal opening up to the first knuckle.
Begin by applying gentle but firm pressure down towards the 6:00 position.
As you feel pressure, practice relaxing into the sensation. As you feel your perineal muscles relax, you may be able to sink deeper into the stretch. Most people hold this stretch for 1-2 minutes.
Repeat this process at 5:00 and 7:00, drawing diagonally down towards each sit bone. You may choose to repeat this cycle in the 5/6/7:00 positions.
If it is comfortable, you can also apply pressure in a sweeping motion from 4 to 8:00, in addition to the sustained pressure described above.
After you are done, wash away the lubricant.
The goal is to feel a strong but comfortable stretch. This means no more than 4/10 discomfort. Reduce your pressure if needed. If someone is performing this massage on you, communicate clearly to help them find the right pressure.
Preparing for Birth? We’re Here to Help.
Perineal massage is just one part of preparing your body for labor and delivery. A pelvic floor physical therapist can also help you improve pelvic floor mobility, learn effective breathing and pushing strategies, reduce pregnancy-related pelvic pain, and feel more confident heading into childbirth. Research suggests that preparing the pelvic floor during pregnancy may help improve pelvic health outcomes and support postpartum recovery.
At Agile Physical Therapy, our pelvic floor specialists provide individualized, one-on-one care to help you stay active throughout pregnancy and prepare for delivery with confidence. We offer one-on-one, 60-minute pelvic floor physical therapy appointments at our San Mateo, Palo Alto, and Los Gatos clinics. If you don’t live near one of our locations, we also offer virtual pelvic floor physical therapy for residents of California and Massachusetts, allowing you to receive expert guidance from the comfort of your home. Virtual visits can be an excellent option for pregnancy and postpartum education, exercise progression, birth preparation, movement coaching, and many other pelvic health concerns.
