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Perineal massage: Is it really a massage?
As you approach the final weeks of pregnancy, you may be exploring different ways to prepare your body for birth – and one practice that often comes up is perineal massage. This technique involves manually stretching and massaging the perineal tissue (the area between the vaginal opening and the anus) in the weeks leading up to labour, with the goal of increasing flexibility and reducing the likelihood of tearing or the need for an episiotomy during vaginal birth.
But like anything in birth preparation, it’s important to weigh up the benefits, limitations, and potential risks before deciding if this is right for you.
Although it’s referred to as “perineal massage,” it’s important to note that this technique is not massage in the traditional sense. What’s actually being done is intentional stretching of the perineal tissue, rather than the rhythmic or circulatory movements we typically associate with massage. The goal is to simulate the pressure and stretching the area might experience during second stage labour.
That said, gentle external massage of the perineum using something like organic coconut oil or a high-quality perineal preparation oil may be more comfortable and effective for some women. This type of surface-level massage can help soften the tissues, increase circulation, and improve elasticity – all without the need for internal manipulation.
This gentler approach may be particularly supportive for those who find internal stretching triggering or uncomfortable and still want to prepare the area in a more nurturing, less invasive way.
Some pelvic health physiotherapists recommend using a pelvic floor wand to assist with perineal massage. These tools are designed to help reach the internal muscles and fascia more effectively, especially for women who find using their hands challenging due to limited mobility or discomfort. If using a wand, it’s essential to receive guidance from a qualified pelvic floor physio to ensure the technique is safe, gentle, and appropriate for your body.
Women’s Health Physiotherapist Georgia from Bien Australia demonstrates how to do perineal massage using a pelvic floor wand:
https://youtu.be/rKoq55lkJoU?si=RXAIiP-4aAQ-g98j
You can purchase a pelvic floor wand and other tools from Bien Australia:
Several studies have looked at perineal massage, particularly in first-time mothers.
Here’s what the evidence tells us:
May reduce the risk of perineal trauma
A Cochrane review (Beckmann & Garrett, 2006) found that women who performed perineal massage from around 34 weeks of pregnancy had a lower risk of perineal trauma requiring stitches, particularly for first-time mothers.
Decreased need for episiotomy
Regular perineal massage may also reduce the likelihood of an episiotomy – a surgical cut made during birth – which can lead to longer recovery times and more discomfort postpartum.
Greater awareness and preparation
Perineal massage helps women become more familiar with the sensations of pressure and stretching in the perineal area, which can reduce fear of the unknown and encourage relaxation during second stage labour.
Improved postpartum recovery
Some women report feeling more in control during birth and having fewer stitches or faster healing, although this is anecdotal and individual.
While perineal massage may seem like a natural technique, it’s important to recognise that anything being done to the body that isn’t part of its innate, physiological process is, by definition, an intervention. That doesn’t make it wrong or unnecessary – but it does mean it should be considered with the same level of awareness and consent as any other hands-on technique.
Even with good intentions, manipulating the body – particularly an area as delicate as the perineum – can have consequences if not done mindfully or with proper knowledge.
https://youtu.be/3vBqSO7F_WE?si=WJrVhwyaAikQTMew
While perineal massage is generally safe for many women, there are important cautions to consider:
Tissue trauma if done incorrectly
If women or their partners are unsure of the correct technique, this practice can cause bruising, microtears, or trauma. This is a sensitive area — overenthusiastic stretching can do more harm than good.
Discomfort or irritation
Done too often, without adequate lubrication, or with too much pressure, massage may lead to soreness or irritation of the area.
Triggering for trauma survivors
For those with a history of sexual trauma or body-based trauma, internal perineal stretching may feel invasive or emotionally distressing. Always prioritise emotional safety over technique.
Infection risk
Good hygiene is crucial. Avoid perineal massage if you have any infections (such as thrush, herpes, or other STIs) to prevent spreading bacteria or viruses.
Not a guarantee
Even with regular massage, tearing can still occur. A range of factors – including baby’s position, speed of the birth, birthing position, and provider approach – all influence perineal outcomes.
Perineal massage may be beneficial, particularly for first-time mothers or those who previously experienced tearing and are looking for ways to prepare. Some women find it helpful and reassuring, while others prefer not to do it at all.
Both are valid choices.
It’s essential to feel informed, comfortable, and confident in whatever you decide to do. And remember not doing perineal massage doesn’t mean you’re unprepared for birth – it just means you’ve chosen a different path that feels right for your body and your experience.
Perineal massage is often promoted as a helpful technique to prepare for birth, but it’s not a one-size-fits-all solution – and it’s not truly a “massage” in the way we usually understand it. What you’re actually doing is stretching the tissues, and that comes with its own considerations.
For some, it offers a sense of preparation and familiarity. For others, it may feel uncomfortable or unnecessary. There are other gentle ways to support perineal health, such as using oil externally, warm compresses, and tuning in to your body’s instincts during birth.
As always, if you’re unsure, speak with your midwife, doula, or childbirth educator for guidance specific to your circumstances – and trust that the best preparation is the one that honours you.
The fear of perineal trauma can be the inhibitor of birth
https://vickihobbs.com/the-fear-of-perineal-trauma-can-be-the-inhibitor-of-birth/
The clitoris and the perineum
https://vickihobbs.com/the-clitoris-and-the-perineum-the-holy-grail-of-womanhood/
The Curse of the Due Date
https://vickihobbs.com/the-curse-of-the-due-date-and-the-eviction-notice-for-your-baby/
If you have any questions or would just like more information please don't hesitate to get in touch by clicking the button below and filling out the contact form.
Contact Vicki