Perineal massage is a manual technique applied to the tissue area between the vaginal opening and the anus, known as the perineum. This practice is typically recommended late in pregnancy to help the body prepare for a vaginal birth. The primary goal is to increase the elasticity and flexibility of the perineal tissues. Performing this massage may help reduce the risk of a severe tear or the need for an episiotomy during the pushing stage of labor.
Understanding the Purpose and Timing
The stretching action of perineal massage works to soften the tissue that must expand significantly during delivery. Preparing this area helps the skin and underlying muscles become more accustomed to the intense pressure of a baby’s head passing through. This may lower the likelihood of needing stitches for perineal trauma, particularly for individuals having their first vaginal birth.
Medical recommendations generally suggest beginning the massage routine around the 34th or 35th week of pregnancy. Starting this practice too early has not shown additional benefits and is not generally advised by healthcare providers. A consistent routine is beneficial, with suggestions ranging from three to four times per week or even daily until delivery. Each session should be performed for about five to ten minutes to allow adequate time for stretching and relaxation of the tissues.
Preparation and Essential Supplies
Before beginning the massage, ensure high hygiene to prevent introducing bacteria. Always wash your hands thoroughly with soap and water, and trim your fingernails to avoid accidental scratches. A lubricant minimizes friction and makes the stretching more comfortable.
Safe options include natural, food-grade oils such as almond oil, coconut oil, or olive oil. A water-soluble personal lubricant can also be used, which avoids potential oil residue. Avoid synthetic products like mineral oil or petroleum jelly, as these may irritate the skin or increase the risk of infection. Find a comfortable and private position, such as semi-reclined in bed with pillows supporting your back and knees bent, or standing with one foot propped on a stool.
Step-by-Step Self-Massage Technique
The self-massage technique is best performed using the thumbs, as this positioning allows for the greatest reach and control over the stretching motion. Begin by applying a small amount of your chosen lubricant to your thumbs and the perineal area. Gently insert one or both thumbs approximately one to one-and-a-half inches into the vaginal opening.
Once your thumbs are positioned, apply gentle, sustained pressure downward toward the rectum (the 6 o’clock position). Hold this initial pressure until a distinct stretching sensation is felt, which may include slight tingling or burning. Hold this downward stretch steadily for approximately one to two minutes, focusing on relaxing your pelvic floor muscles.
After the sustained hold, begin the U-shaped massage motion by sweeping your thumb(s) along the sides of the vaginal wall, moving from the 6 o’clock position toward the 3 o’clock and 9 o’clock positions. This side-to-side movement should be firm enough to feel the stretch but should not cause sharp pain. The motion is repeated in a slow, rhythmic pattern, gently moving back and forth across the lower half of the vaginal opening.
Continue this U-shaped sweeping motion for the remaining duration of the session, typically five to ten minutes in total. The consistent pressure and stretching help increase blood flow and encourage the tissues to become more pliable. As the tissue becomes accustomed to the stretch over multiple sessions, you may gradually increase the depth of insertion and the amount of pressure applied.
Important Considerations and Precautions
While the massage should not be painful, it is normal to experience a strong sensation of stretching or slight burning, particularly during the initial static hold. This feeling is beneficial, as it helps you become familiar with the pressure sensations you will feel during labor. Maintain a firm but gentle pressure, and immediately stop if you feel any sharp or persistent pain.
There are specific situations where perineal massage should be avoided. The practice is contraindicated if you have an active vaginal infection (such as thrush or genital herpes), as the massage could potentially spread the infection. You should also refrain from performing the massage if you are experiencing:
- Unexplained vaginal bleeding
- A low-lying placenta (placenta previa)
- Other pregnancy complications advised against by your healthcare provider
Always consult with your doctor or midwife before beginning any new practice during pregnancy.