The Ultimate Guide for Perineal Massage for 2022

Perineal massage is recommended by doulas and midwives to reduce tearing and pain

Having a baby is exciting, especially for first-time moms. If you are planning to give birth the natural way, it helps to prepare well for the journey ahead. Although the human body is capable of amazing feats—including giving birth to a baby—all that pushing and heaving can cause trauma to the perineum. Perineal massage during pregnancy may help reduce childbirth pains and even prevent tearing.

What is perineal massage?

There is nothing you want more than for your baby to have a normal childbirth—except maybe less perineal trauma for you. Perineal massage during the late stage of pregnancy has been used for generations to prepare the perineum for delivery. It loosens the tight perineal muscles, which softens and flexes the birth canal.

Perineal massage is recommended by healthcare organizations: many studies have shown that it successfully reduces perineal trauma during birth, and can even allow you to recover faster, with less pain. Perineal massage can be done by you or a partner.

The best time to get perineal massage is anytime from the 3th or 35th week of your pregnancy. Some studies have shown that the more frequently it is done, the lower the risk of perineal tears [4].

Your Perineum and Childbirth

The perineum is the area between the vagina and the anus. This diamond-shaped area is comprised of a thin layer of subcutaneous tissue (aptly called perineal muscles) and skin. The perineum connects with the pelvic floor muscles, which support the pelvic organs such as the bowels and bladder. A damaged perineum may weaken the pelvic floor muscles.

During a vaginal birth, the perineal muscles stretch and expand to give way to the baby. This can inflict trauma to the perineal muscles, causing painful lacerations that may require stitches. This injury is called perineal tearing and it is very common.

Studies show [1] that over 85% of women who gave birth vaginally suffered some perineal trauma. Of these women, 25% required stitching[2], which makes the healing process longer and more painful. While only a small percentage of women suffered a severe form of perineal tearing, it’s still important to prepare the perineum prior to giving birth. Unfortunately, the rate of perineal damage in women has increased over the past years [3].

What are the Benefits of Perineal Massage during Pregnancy?

Reduced Pain and Quicker Delivery

The vaginal region goes through many changes prior to giving birth. The body will release a hormone called relaxin[5] to loosen the joints and muscles for easy delivery. However, giving birth to a large baby or giving birth for the first time stretches the vaginal muscles to their limits. This could lead to perineal injuries. A soft, elastic perineum helps ease the baby out during delivery, making the entire process of childbirth easier and quicker than normal.

Massaging the perineum boosts blood circulation in the vaginal area. Better blood circulation improves the muscles’ ability to stretch and accommodate the baby’s head.

Reduces Episiotomy and Injuries

In normal childbirth, the doctor or midwife would ease the baby’s chin and head out of the birth canal. But there are cases when the opening is not wide enough to accommodate the head or shoulders of the baby. In such cases, the doctor would perform a procedure called episiotomy [6]. The doctor would make a small incision in the perineum to open up the perineum as the baby is being pushed.

An episiotomy will require anesthetic to numb the area unless an epidural or other anesthetics have been administered prior to giving birth. After the placenta is delivered, the doctor would stitch the perineum using dissolvable sutures.

Perineal massage before birth may minimize the risk of perineum injuries, especially among first-time moms. A study found that women who massaged their perineal muscles prior to giving birth are less likely to require an episiotomy. Researchers said that it helps reduce episiotomies by up to 16%  [7] for first-time mothers. Experienced mothers who massaged their perineum before giving birth reported less pain 3 months after the recovery period.

Decreased Risk of Spontaneous Perineal Tearing

A spontaneous perineal tear refers to the laceration of the skin and other soft tissues of the perineum during vaginal childbirth. This condition is classified into first-, second-, third-, and fourth-degree tears.

A first-degree tear is the minor tearing of the perineal skin. A second-degree tear involves the tearing of the skin and perineal muscle. The third-degree tear involves the tearing of the fourchette, perineal skin, vaginal mucosa, muscles, and anal sphincter. A fourth-degree tear involves the fourchette, perineal skin, vaginal mucosa, muscles, anal sphincter, and rectal mucosa.

Minor tearing may require no treatment or stitches. Severe tears could cause profuse bleeding, long-term pain, infections, and in extreme cases, dysfunction. Severe cases of spontaneous perineal tearing may require surgical repair.

Perineal massage may decrease your risk of spontaneous perineal tearing. The massage aids in the quick delivery of the baby that contributes to maintaining an intact perineum [8].

Faster Recovery from Childbirth

After giving birth, most women experience pain and swelling of the perineum. Recovery is slower for moms who had an episiotomy. 

Regular perineal massages in preparation for childbirth can speed up healing after giving birth. When the perineum is soft and elastic, the muscles can withstand the trauma caused by delivering a baby, allowing a new mother to bounce back immediately after giving birth.

What Science Has to Say about Perineal Massage

There is scientific evidence of how effective perineal massage is in minimizing perineal trauma during childbirth. Below are just a few of the many clinical studies demonstrating its potential benefits :

A 2006 study by Beckmann and Garrett found that subjects without a previous vaginal birth (first-time mothers) who were randomly assigned to do perineal massages had a 10% decreased risk of tearing [9] that requires stitches. The researchers conducted 4 randomized controlled trials that enrolled 2,497 pregnant women. Researchers concluded that the risk of episiotomy among first-time mothers has decreased by 16% after getting perineal massage. Researchers also concluded that the likelihood of perineal trauma has decreased [10] in women who were doing it regularly.

A study [11] by Emmanuel Onyebuchi Ugwu, et al. explored the benefits of perineal massage. Research shows that women who received the massages have a reduced incidence of episiotomy. The researchers also encouraged obstetricians to add perineal massage as part of their routine prenatal care for first-time pregnancies to minimize perineal trauma during vaginal birth. The randomized controlled trial involved monitoring 108 first time mothers.

separate study [12] confirmed “Women who have not had a previous vaginal delivery and perform digital perineal massage in the final month of pregnancy experience less perineal birth trauma, mostly through fewer episiotomies, than those who have not performed massage.” Although more research is needed to determine the benefits of perineal massage, researchers agree that the results of the trial were “methodologically good, so their combined results are likely to be sound.”

In their research [13], Labrecque, M., E. Eason, et al. concluded that: “Based on the results of this pilot study, a randomized, controlled trial to evaluate the efficacy of perineal massage in preventing perineal trauma at birth appears feasible.” The study examined 174 women who were 32 to 34 weeks pregnant. “Twenty (91.0%) of the 22 women in the massage group returned their perineal massage diaries. Based on the postpartum questionnaire, 20 women practiced the technique at least four times a week for three weeks or longer. ”

A review [14] by Carmen Imma Aquino, et al. concluded, “perineal massage during labor is associated with significant lower risk of severe perineal trauma, such as third and fourth degree lacerations.” The study was comprised of 9 trials and 3374 pregnant women were analyzed. A midwife did perineal massage in the second stage, during pushes or between and during pushes. Women who received perineal massage during labor showed a significant lower incidence of severe perineal trauma compared to women who did not receive perineal massage.

Use the Right Oils for You

Lubrication makes the massage more comfortable. Lubricants soften and hydrate the perineum tissues. The best perineal massage oils are mild, all-natural oils. Opt for oils that reduce inflammation and improve skin elasticity. Some types of oils could also reduce the risk of scarring. We highly recommend these oils:

- Almond oil
- Olive oil
- Vitamin E oil

Avoid oils that could increase your risk of vaginal infections. Avoid water-soluble lubricants that contain high levels of salt/ion. These products could irritate the delicate vaginal tissues. Cream products, essential oils with a strong scent, regular body massage oil, or perfume oils are not recommended. Avoid using petroleum-based oils like petroleum jelly, mineral oil, or baby oil.

Traditional ways to perform a perineal massage:


On your own

Reaching the perineum on your own is a challenge when the baby bump is in the way.
However, it’s possible if you are flexible enough and have patience.

Here is how to do it on your own:

Step 1
Prepare

Get into a comfortable position. If you are lying down, prop your legs up with pillows for support and keep the knees bent. If you are sitting down, try squatting down with your back to the wall for support.

pour oil

Step 2
Apply oil

Pour about a teaspoonful of your favorite massage oil and apply all over the fingertips and thumbs. Place one or both thumbs on the back wall of the vagina with your forefingers resting on the buttocks. 

Step 3
Insert fingers

Press and move the fingers down towards the anus in a rhythmic, gentle movement. Insert your index or middle finger/s into the vagina, resting the palms against the inside leg.

Step 4
Massage

If you are massaging the perineum for the first time, imagine that your vaginal opening is a clock face. Pull your two fingers down to 6 then stretch outwards to 3 using gentle pressure. Repeat 20 to 30 times then repeat on the opposite side, 6 to 9.


With a partner

Perineal massage can be done by a partner. Studies have shown that in some cases this brings couples closer, but in others it causes embarrassment and tension.

If you have a partner help you with perineal massage:

Step 1
Prepare

Your partner sits across from you.

pour oil

Step 2
Apply oil

Before the massage they should apply about a teaspoonful of massage oil over the fingertips and thumbs.

Step 3
Insert fingers

The partner then places one or both index fingers on the back wall of the vagina.

Step 4
Massage

The fingers are pressed and moved down towards the anus in a rhythmic, gentle movement. Continue for about 5-10 minutes each time.

The Modern Way to do Perineal Massage with Perimom

The Perimom Perineal Massager was designed to empower you to do perineal massage completely on your own, whenever you want. You can easily reach your perineum and start conditioning it for childbirth within minutes.

Note: The clinical data above was generated using the traditional method.

Sit and relax

Sit and relax

Sit comfortably in a semi-reclined position on a clean towel.

Hold Perimom in your right hand

Hold Perimom

Hold the top end of Perimom's firmly in your right hand.

Pour almond or other massage oil

Pour massage oil

Oil the smooth concave bottom tip of the Perimom.

Insert Perimom

Insert and stroke

Insert and start stroking the perineal area with the smooth rounded bottom of the device

Massage Your Perineum

Massage your perineum for 5-10 minutes. Repeat the massage three times a week, but consult with your healthcare professional.

Perineal Massage Tips and Techniques

Get Comfortable

Getting comfortable helps you reach the perineum easily. This is especially true when you are heavily pregnant and you’re doing the massage yourself. Being in a comfortable position before and during the massage is key to relaxing the perineal muscles. Since you are in a comfortable position, you are less tense, which relaxes the muscles.

Some women are more comfortable having the massage while lying down, others prefer sitting up. You could also try standing up and elevating one foot on a chair during the massage. Choose the position that is most comfortable for you.

Feel the stretch (it shouldn't hurt though)

As you massage the insides of the vagina, you will feel the skin outside of the vagina stretching. Use gentle pressure as you massage the perineum. Focus on the rhythmic motions of the fingers and breathe in and out deeply to relax and stretch the muscles. It’s normal to feel a slight burning sensation during the first few tries. But the massage shouldn’t be painful.

Use Warm Water

Using warm water makes for a relaxing massage. Warm water helps to soften and loosen taut muscles. You can take a warm bath during or before the massage or apply a warm compress to the perineum for 10 minutes before the massage.

Clean Hands

You are aiming to massage the insides of the vagina, not the outside skin, so clean hands are a must. Trim your nails prior to the massage and wash your hands thoroughly. Then, put about a teaspoonful of lubricant on the thumb and fingers and you are ready to start the massage.

If you are using the Perimom Perineal Massager, wash it thoroughly with warm water and soap.

Get a Mirror

Giving yourself a perineal massage for the first time might seem daunting but doing it in front of the mirror helps because you can see exactly what you are doing.

Conclusion

Perineal massage during pregnancy is no longer an old wives’ tale. Clinical studies show it helps reduce the risk of spontaneous perineal tearing in women. Massaging the perineum also decreases the chances of getting an episiotomy.

First-time mothers, in particular, will benefit from regular perineal massages because toned perineal muscles are likely to stay intact [15] in a vaginal birth. In addition, pregnant women who are 30 years old and older will benefit from regular perineal massage especially during the last few weeks of the pregnancy. Simply put, perineal massage during pregnancy could make the delivery easier and lower the pain of recovery.

Perimom

The new way to
perform a massage

Resources

1. https://www.motherlylove.co.uk/the-importance-of-massaging-the-perineum-in-pregnancy/
2. https://theconversation.com/what-we-know-about-perineal-tearing-and-how-to-reduce-it-during-childbirth-6321

3. https://www.vaginacoach.com/blogs/news/15058045-5-tips-for-perineal-healing-postpartum

4. https://www.ncbi.nlm.nih.gov/pubmed/1130098

5. https://www.bellybelly.com.au/pregnancy/perineal-massage/

6. https://www.beingtheparent.com/relaxin-hormone-during-pregnancy/

7. https://www.ncbi.nlm.nih.gov/pubmed?term=16437520

8. https://www.ncbi.nlm.nih.gov/pubmed/1007613

9. https://www.ncbi.nlm.nih.gov/pubmed?term=1643752

10. https://www.ncbi.nlm.nih.gov/pubmed?term=16437520

11. https://www.cochrane.org/CD005123/PREG_antenatal-perineal-massage-for-reducing-perineal-trauma

12. https://www.ncbi.nlm.nih.gov/pubmed/2960758

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

14. https://www.ncbi.nlm.nih.gov/pubmed/1007613

15. 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