Tips to Stay On Track with Perineal Massage

If You’ve Ignored Your Perineum Until Now…

Don’t feel bad. The fact that the anatomy of the perineum is inside the human pelvis and can’t be easily seen makes it hard to understand the structures involved. “Private part discussions” aren’t common occurrences for most women, and making matters worse, incorrect language is often used to discuss female reproductive and pelvic anatomy. This creates confusion around what is basically a simple process – to stretch and relax the perineal muscles which are no different than any other muscles in our body.

The perineum in women is basically what most of us consider our “crotch”. If you squat down and pat between your legs, the area you are patting is your “perineal” area. It includes the area at the back of your vagina and vulva and goes to your anus and rectum. Specifically, the perineum includes the back portion of a woman’s birth canal.

While most of a woman’s birth canal tissues are stretchy, this back perineal area is more rigid and firm. It is made up of several layers of muscles and connective tissue (fascia) that create a strong pelvic floor, so we humans can walk upright without having issues. Without an intact or healthy perineum every time humans coughed, sneezed, or simply moved around, we would urinate and defecate without control.

For an easy to follow 3-D explanation of the perineum and pelvic floor tissues involved in childbirth, visit The Pelvic Floor Part 1 and Part 2.

The perineum thus has two very different jobs in women. For 99.99% of the woman’s life we want a strong, tight perineum so we can run and jump and laugh without peeing or worse. But when it comes time for childbirth we want a flexible, stretchy perineum so the baby can come out without tearing of these tissues.

In our human past, women squatted to eliminate. Squatting and contracting our perineal muscles to defecate or urinate all worked to flex and stretch these muscles on a regular basis, keeping them strong, yet flexible, without women giving them a second thought. In contrast, the perineal muscles of modern women get little exercise. And just like our calves or triceps, if we don’t stretch these muscles they become tight and rigid, which is OK until… we want our birth canal to open during childbirth. Then suddenly, this often-ignored part of our anatomy becomes a major player in our lives.

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Stretching the Perineum Is Similar to Stretching Any Other Muscle!

Physiologically, perineal massage functions just like massage and stretching work on other muscles in our body, such as our hamstrings or trapezius, to loosen and release tension. But realistically these muscles are tucked deep inside our pelvis, and are bordered by our genitals and rectum. Lengthening and relaxing these perineal muscles isn’t quite as graceful as doing a shoulder stretch in our favorite new yoga top. That said, it isn’t as hard or confusing as some educational material out there makes it sound.

With regards to technique, in general terms, perineal massage is a daily stretching of the back of the birth canal, where the muscles form a tight U-shaped rim at the back side of the vaginal opening, using fingers or thumbs. The goal of perineal massage is to make this firm ridge more stretchy and supple so that it naturally expands during childbirth. This perineal massage increases the flexibility of the perineal muscles and decreases their resistance during labor enabling the perineum to stretch at delivery without tearing or needing cutting.

The critical thing to remember about perineal massage is that if you are feeling a stretching and mild muscle burn through the use of your fingers as you massage and press against the back portion of your birth canal (your vaginal opening), you are doing valuable perineal massage. It doesn’t have to follow a textbook definition of how the massage should be done to be useful. At least half of women who start perineal massage, and over 75% of women who have heard of the technique, find it challenging to do daily massage during the last several (4-6) weeks of pregnancy. If every other day or even 2x per week is the best you can do, rest assured it is still of great value to you.

I’m Busy and Tired – How Do I Stay Motivated?

Childbirth happens on one specific day of a woman’s life, but the perineal trauma that can occur during this day can impact a woman’s sex life, her urinary and fecal continence, and her chances of chronic genital pain for a lifetime. Practicing perineal massage a few minutes a day for a month ahead of childbirth is well worth the hassle and time for the chance of fewer long-term permanent changes to our bodies during labor and delivery.

Perineal massage helps the mom-to-be experience the unique burning sensation of these perineal muscles as they stretch, and helps her learn to breathe through this new feeling. Most of us have done stretches for tight calf or neck muscles, and have trained ourselves to instinctively breathe through the burn as we coax these body parts to lengthen and relax. It is much more productive for a pregnant women to “feel the burn” of her perineal muscles for the first time in a relaxed setting where she can practice breathing as she works to release tension, versus encountering this sensation for the first time in the rush of labor at the hospital. If this perineal burning sensation is completely new to a woman in labor, it can make her suddenly tense these muscles, at the very time she needs to be relaxing them, thereby increasing her chances of perineal trauma.

Let’s face it, practicing perineal massage requires motivation and discipline without any immediate obvious benefit. Some days it will be easy. Some days you won’t want to do it. But stay on task knowing it is a proven technique that women have used around the world and through the ages to prepare for motherhood. Sadly, in spite of medical evidence showing possible life-time benefits of the massage for women, there has been a significant lack of patient education on how to make perineal massage work in real life for most women. In fact, less than 5% of pregnant women even know the correct techniques for perineal massage. This is disappointing given that perineal massage done consistently enhances the chance of an easier, less painful and less traumatic delivery with less risk of future pelvic floor dysfunction.

The National Institutes of Health states that “not having an episiotomy is best for most women in labor”, it further suggests that perineal massage is one of the key things women can do to avoid an episiotomy. Five minutes of perineal massage each day during the last several weeks of pregnancy is all it takes to reduce the chance that you will experience perineal trauma and painful sex after having a baby.

Tips to Successful Perineal Massage During Pregnancy

  • Most women will want to start the practice at 34 weeks of gestation, but be sure to check with your midwife or doctor before starting
  • Use a non-irritating massage gel, like BabyIt, to increase slipperiness and comfort during your massage
  • Massage daily, or a minimum of four times per week, for 4 to 5 minutes each day
  • Feel a slight (but not overwhelming) burning sensation the first week or two especially as the perineal tissue is stretched backwards
  • Take comfort in the fact that you are feeling this burn or stretching, as it indicates you are doing the massage correctly

Common Concerns, Difficulties, and Solutions

There are several reasons why pregnant women seem to shy away from doing perineal massage:

  1. women have too little information about how to perform perineal massage once pregnant bodies become difficult to work around
  2. women lack confidence that they are “doing it right”
  3. women lack information about the benefits of perineal massage for keeping their perineal tissues healthy for the rest of their lives

Addressing some of the common concerns women have with perineal massage and how to navigate these issues can help ensure success. The information on this site is meant to help empower you with the information to make a great choice for your body.

Here are some of the difficulties that women report when practicing perineal massage, and some solutions for you to try.

Long Fingernails: Unless you plan on having your partner do all the massage, the nails really do have to go. Besides you will want to have shorter nails with a newborn anyway. Better chance for less pain after childbirth and a more satisfying sex life versus long nails?? Come on Ladies!

Proper Technique : The first few times you do perineal massage it will seem so simple you will feel certain you are doing it wrong. Do what feels right to you. There are lots of different positions you can try such as reaching from behind with one foot raised in the shower. Remember, the important thing is stretching, massaging and feeling that burn, however you need to get there.

Partner Apathy: If your partner doesn’t seem enthused about doing the massage don’t take it personally. Remind your partner there isn’t really a wrong or right way (other than something super rough), and that any massage is better than no massage. But, doing perineal massage together takes a lot of communication to stretch the perineum enough to feel the burn without you wanting to throw a punch! And sometimes it is just boring to do. Find the right mix of partnered versus solo perineal massage for your house.

For partnered perineal massage try not to do the massage while watching TV (because less active work gets done if either party is distracted). Once your partner starts feeling the tissues relax and soften over the first few weeks, it can be motivational to think about better sex after the baby is born! That said, perineal massage is uncomfortable and not usually a turn on for the pregnant woman. If perineal massage turns into love making – nothing wrong with that, just give yourself a little time to transition from feeling clinical about your vaginal area to sexual.

Fingers Sticking to the Vaginal Lining: The most widely recommended massage product for perineal massage in the past has been almond oil. But almond oil is sticky, it also doesn’t work well in the shower and it can have high levels of contaminating reactive oxygen products that trigger vaginal irritation. In general, oils increase rates of vaginal infection, and although they are often recommended for perineal massage, there is no data supporting their safety during vaginal massage. In fact, one study from Italy with women using almond oil for pregnancy massage showed a negative effect on birthing outcomes. Use a gel such as BabyIt™ that is isotonic to the vagina and contains no parabens or coating oils.

Feeling Ridiculous and Ashamed: It may feel awkward touching yourself this way, and you may want to lock your partner out of the bathroom while you experiment. I suggest getting a mirror to study yourself and have one hand try the massage while you hold the mirror and watch with the other hand. Although perineal massage isn’t particularly sexy, motherhood is very sexy and empowering, so put on some soft music, practice deep breathing and focus on the fact that by doing perineal massage you are doing the best you can to have the safest, most healthy outcome possible for you and your baby.

Feeling Irritation: A moderate burning sensation during the massage as you press towards the back of the perineum is normal, especially in the first two weeks. Extreme pain is a sign to lessen the pressure, and is something you should discuss with your health care professional in case there are anatomical problems they should know about. Burning that lasts after the massage may be triggered by massage products or lubricants that were used. Although many perineal massage sites suggest the use of KY Jelly or Astroglide, these water-soluble lubricants have a high ion (salt) concentration and have been shown to cause severe irritation and even damage of the cells lining the vagina. Of course, using such products every day can cause burning and irritation for some women.