What Is Perineal Massage?

The perineum is the area between the genitals and the anus. During labor, the vaginal opening must dilate, or stretch, sufficiently enough to allow the baby to pass through. If the muscles surrounding the vagina are too tight, there is a risk of tearing the perineum and vaginal muscles during the process of giving birth.

Massage to the perineum may help decrease tightness and increase blood flow. This can be helpful in a vaginal delivery, decreasing the risk of tearing, surgical cutting, and repair of the perineum. As a result, it can reduce pain and other related complications.

Woman Giving Birth with Obstetricians Assisting

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What Is a Perineal Massage?

Perineal massage is a massage to the soft tissue of the perineal area. It can help improve blood flow and decrease tissue restriction for improved flexibility of the perineal muscles.

Massaging the perineal area with the fingers during the final month of pregnancy and during the second stage of labor has been shown to be effective for reducing pain and the severity of perineal tearing during childbirth, especially for first-time mothers who have not given birth via vaginal delivery before.

How To Perform a Perineal Massage

Perineal massage in the final month of pregnancy can be performed by yourself at home while perineal massage during labor requires the help of another person. You may want to use a water-based lubricant to decrease friction, which will make the massage more comfortable.

To perform a perineal massage:

  • You will lie on your back with your legs spread apart.
  • You, your partner, or a healthcare worker will put on a pair of gloves and insert two fingers two to three centimeters, or about one inch, into your vagina.
  • You or the person helping you will then press the fingers down into your vaginal wall. While applying pressure, the fingers should move side to side in a U-shaped pattern. This movement should be performed between two and 10 minutes to help relax the vaginal and perineal muscles.

Purpose 

During childbirth, the risk of tearing the perineum is significant. It has been reported that up to 85% of people who deliver babies via vaginal delivery will experience it. Approximately two-thirds of perineal injuries from labor require surgical repair, and significant pain results in more than 60% of perineal injuries from childbirth.

Importance

Damage to the perineum can extend to the vaginal wall and internal and external anal sphincters, the rings of muscle fibers around the anus that control bowel movements. Complications that can result from perineal injuries include:

  • Bleeding
  • Hematomas
  • Infections
  • Painful sexual intercourse
  • Urinary and fecal incontinence

These complications can cause significant discomfort. Perineal tearing and resulting pain can cause difficulty walking and sitting.

While research is ongoing, current evidence suggests that perineal massage can increase the elasticity and blood supply to the perineum, resulting in less muscle resistance and allowing the perineum to stretch more during labor without tearing. This can help decrease the severity of perineal tearing, decrease the need for episiotomy, and decrease pain postpartum as well as associated complications.

What Is an Episiotomy?

An episiotomy is when the perineum and vaginal wall are surgically cut to enlarge the vaginal opening. The incision is then closed with stitches. While sensation is numbed so that the incision and stitches are not felt during labor, significant pain and similar complications from perineal tearing can result from episiotomies. This is not routinely recommended in the United States.

Clinical Evidence

In a randomized controlled trial, a group of mothers who received a perineal massage for 30 minutes during the second stage of labor had an overall decrease in the severity of perineal tearing compared to those who did not receive a massage. Most of the tears were of mild severity and did not need to be repaired with stitches. Overall pain after delivery was also significantly reduced.

A review of studies also supports the use of perineal massage to lower the risk of severe perineal tears. While some tearing may happen during childbirth, the extent of tearing may be very minimal and significantly less painful when the perineal muscles are able to stretch more without resistance.

In another randomized controlled study, gynecology residents performed perineal massage by inserting their fingers two to three centimeters into the vaginas of pregnant mothers and applying pressure to both sides of the vaginal wall for two minutes. This process was repeated four times during the first stage of labor with 30 minutes of rest in between.

The residents then performed a 10-minute massage at the start of the second stage of labor. Results from the study revealed a significantly lower need for episiotomy and decreased severity of perineal tearing in the group of mothers who received a perineal massage compared to those that received no massage during labor.

Summary

A perineal massage may help stretch your perineal and vaginal muscles, and reduce tearing of these muscles during childbirth. It will also lower your chances of getting an episiotomy, leading to less pain and better quality of life after giving birth.

A Word From Verywell

Perineal massage may help improve the flexibility of your perineal muscles and improve their ability to stretch during labor. This can help decrease the severity of perineal tearing and need for an episiotomy. By keeping the perineal muscles more flexible, complications from perineal tearing during labor can be significantly reduced to decrease postpartum pain and make it easier to care for your newborn.

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3 Sources
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  1. Shahoei R, Zaheri F, Nasab LH, Ranaei F. The effect of perineal massage during the second stage of birth on nulliparous women perineal: A randomization clinical trial. Electron Physician. 2017;9(10):5588-5595. doi:10.19082/5588

  2. Akhlaghi F, Sabeti Baygi Z, Miri M, Najaf Najafi M. Effect of perineal massage on the rate of episiotomy. J Family Reprod Health. 2019 Sep;13(3):160-166.

  3. Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017;6(6):CD006672. doi:10.1002/14651858.CD006672.pub3