The benefits of perineal massage during pregnancy

Is there such thing as a bad massage? Most people would say no. Massage can relieve stress, aid in physical and mental health, and help with healing.

One type of massage has an added benefit: Perineal massage can reduce the risk of tearing or the need for an episiotomy, a surgical cut performed by a doctor to widen the vaginal opening, during childbirth.

“The pelvic floor consists of layers of muscles and connective tissue at the base of the pelvis,” says Vanessa Tipon Figuero, a pelvic health physical therapist for Sharp HealthCare. “The muscles and tissue support the pelvic cavity and control sexual function, urination and defecation. Many women worry about the possibility of tearing in this area — usually at the perineum, the area between the vulva and the anus — when giving birth.”

For a small percentage of new mothers, about 6%, a perineal injury during vaginal delivery will result in a third- or fourth-degree tear, which means the tear affects the anal sphincter muscle. This can increase the time it takes to recover from childbirth and lead to scarring and other concerns.

“While approximately 90% of first-time moms will experience some perineal injury or degree of tearing during birth, these tears are often minor and will heal well post birth,” Tipon Figuero says. “However, third- and fourth-degree tears may cause more significant pelvic floor dysfunction, including urinary and fecal incontinence, chronic pelvic pain and sexual dysfunction.”

Fortunately, it’s possible to reduce your risk of tearing during childbirth. “Research demonstrates that perineal massage is one of the most effective interventions in the prevention of perineal lacerations and injury during birth,” says Tipon Figuero.

How to perform perineal massage

Tipon Figuero recommends starting perineal massage at week 34 of your pregnancy. You should perform perineal massage four times a week for about four minutes each time.

To prepare, consider taking a warm bath or shower, or applying a warm washcloth to the pelvic floor to relax the tissues. “This massage is much easier when you relax the pelvic floor muscles — the muscles that you tighten to hold in urine or gas — and perform deep breathing in order to relax your whole body,” Tipon Figuero says.

Then follow these steps:

• Use a lubricant or oil and insert one to two fingers or thumbs about 4 centimeters into the vagina.

• Apply firm but gentle pressure straight down on the perineum, holding the pressure until the area feels numb for one to two minutes. Some burning, tingling or stinging may occur but it shouldn’t be painful.

• Gently move your fingers or thumbs along the sides of the vagina, stretching it from side to side.

Perineal massage can be performed in a variety of positions, Tipon Figuero says. “As your baby and belly are growing, you may need the help of your partner to perform perineal massage.”

Stop performing perineal massage if you begin to feel faint, dizzy or have physical discomfort. And as always, talk with your doctor if you have concerns about your health or the health of your baby during pregnancy. Perineal massage should not be performed while on pelvic rest, also called bed rest.

Watch a video to learn about the anatomy of the pelvis; perineal injuries that may occur during birth; and how to correctly perform perineal massage to decrease perineal injury during birth. Learn more about pregnancy and childbirth programs and services at Sharp.