Perineal massage is a type of massage performed on the perineum, the area between the vaginal opening and anus. It helps stretch and strengthen the perineal muscles, which may make it easier for the baby to pass through during vaginal delivery and reduce the risk of perineal tears.

Perineal massage can be done at home, although it should ideally be performed with guidance from an OB-GYN, obstetrician, or pelvic floor physical therapist. Professional guidance can help ensure that the massage is performed correctly and safely.

Massaging the perineum can help increase lubrication, make the skin more flexible, and improve muscle strength and elasticity. It may also increase comfort and sexual pleasure.

What it is for

Perineal massage during pregnancy is used to increase the elasticity of the perineum.

This can help reduce perineal trauma or tearing during vaginal delivery and may make postpartum recovery easier.

When it is recommended

Perineal massage is recommended to:

Prepare the perineum for vaginal delivery;
Reduce the risk of perineal tearing during vaginal delivery;
Reduce the burning sensation that may occur as the baby's head emerges during vaginal delivery;
Reduce the likelihood of needing an episiotomy;
Increase the feeling of being prepared for vaginal delivery.

In addition, perineal massage may help reduce postpartum pain or sexual discomfort that can occur after pregnancy.

Perineal massage is recommended starting at 34 weeks of pregnancy and should be performed with guidance from an obstetrician or obstetric physical therapist.

Schedule an appointment with an obstetrician in your area:

Perineal massage vs pelvic floor massage

Perineal massage and pelvic floor massage differ in how they are performed and in the benefits they provide.

Perineal massage involves inserting the fingers into the vaginal opening, while pelvic floor massage and pelvic floor therapy can help strengthen the pelvic floor through exercises such as Kegel exercises and pelvic floor physical therapy.

One of the main benefits of perineal massage is increasing the elasticity of the perineum, which can make vaginal delivery easier and help reduce perineal trauma.

Pelvic floor massage, on the other hand, can improve blood flow and strengthen the muscles in the pelvic area, helping prevent problems such as urinary or fecal incontinence.

How to prepare

Before performing perineal massage, it is recommended that the pregnant woman be relaxed, such as after taking a shower.

It is also important to keep the fingernails short to prevent cuts or injuries to the vagina.

Before starting perineal massage, wash the hands thoroughly with water and mild soap. A small nail brush can be used to clean carefully underneath the nails.

Which oil should be used?

Sweet almond oil or an unscented vegetable oil can be used for perineal massage. Petroleum jelly and synthetic oils should be avoided.

A water-based lubricant can also be used and may be especially helpful for women who are allergic to oils.

How to perform: step-by-step

The step-by-step instructions for performing perineal massage are:

Sit in a comfortable position with the knees bent and pillows supporting the back;
Drop each knee to their sides and support them with pillows to help relax the inner thigh muscles;
Apply lubricant or oil to the index finger and thumbs, as well as to the perineum and vaginal opening;
Begin by gently massaging the vaginal opening for about 30 seconds using circular, U-shaped motions;
Insert about half the length of both thumbs or the index finger, whichever is easier, into the vaginal opening;
Press the thumbs downward toward the anus until a mild burning, stinging, or tingling sensation is felt;
Hold this position for 1 minute and repeat 2 to 3 times;
Press the tissue outward toward the sides and maintain the stretch for 1 minute.

After perineal massage, wash the hands again and clean the area to remove any excess oil or lubricant.

Ideally, perineal massage should be performed every day starting at 34 weeks of pregnancy to gradually stretch the perineal muscles, which may make vaginal delivery easier.

How to perform massage with EPI-No

EPI-No is a small device that works in a way similar to a blood pressure cuff. It consists of a silicone balloon that is inserted into the vagina and manually inflated by the woman.

This allows the woman to control how much the balloon expands inside the vaginal canal, stretching the muscle tissue, vaginal lining, and skin.

To use EPI-No, lubricant should be applied to the vaginal opening and to the inflatable silicone balloon.

The balloon should first be inflated only enough to allow it to be inserted into the vagina. Once it is positioned, the balloon can be inflated again so that it expands and stretches the perineal muscles and inner vaginal lining.

This device can be used 1 to 2 times per day.

Contraindications

Perineal massage is contraindicated in the following situations:

Before 34 weeks of pregnancy;
Vaginal yeast infection, genital herpes, or any other active vaginal infection;
Rupture of the amniotic sac;
Placenta previa;
High blood pressure during pregnancy or preeclampsia.

In addition, pelvic floor massage should not be performed by pregnant women who have had a cervical cerclage or who experience vaginal bleeding during the second half of pregnancy.

Perineal massage should also not be performed if an obstetrician advises against it.

Perineal Massage: Benefits & How to Perform (Step-by-Step Guide)