How to do pelvic massage during pregnancy

Perineal massage is a method of preparing the tissues of the perineum – the area between your vagina and anus – for vaginal delivery. Massaging this pelvic floor area in the weeks before your baby's birth can help soften the tissues that are stretched as your baby is born. You can do perineal massage yourself, or you can ask your partner to do it for you.

Perineal massage can also be done during delivery to keep the area loose so that it will stretch rather than tear.

There's research going back several decades on the advantages of perineal massage. Despite its proven benefits, though, it's not routinely recommended by doctors and midwives. Your healthcare provider may not bring it up, so if you're interested in perineal massage, ask about it.

Benefits of perineal massage

The benefits of perineal massage include potentially reducing damage to the pelvic floor – the muscles that support your reproductive organs, bowels and bladder. More specifically, perineal massage may help you avoid:

Perineal massage has been proven especially helpful for women having their first vaginal delivery or those with very tight pelvic floor muscles (because of a previous episiotomy or laceration, for example).

When done during the second stage of labor (often together with the application of warm compresses), perineal massage has been shown to significantly reduce the risk of perineal trauma, such as third- and fourth-degree tears.

Practicing perineal massage is also an opportunity to practice your relaxation skills for labor while focusing on the area that will be stretching during delivery. Women who do perineal massage in late pregnancy and during pushing report feeling more in control of their labor.

When to start perineal massage

A good time to start perineal massage is in your third trimester, at about 34 weeks of pregnancy.

Once or twice a week until your baby arrives has been shown to be an effective amount of time, though you can do perineal massage every day if you like.  

Perineal massage shouldn't hurt at all, and it's easy to do. One study of more than 700 women reported that the majority found it to be acceptable, would do it again in a subsequent delivery, and would recommend it to others. Many reported, however, that the massage could be uncomfortable and even cause a painful burning sensation in the first few weeks. By the second or third week, though, the massage became more comfortable and women learned to breathe and relax through the stretching sensations, a practice they found useful during delivery. If you try perineal massage and find it uncomfortable, you may want to do it once a week or so and then increase your sessions gradually.

Some women say they're more comfortable doing perineal massage themselves rather than having their partners do it because they want to be in control of how firm or gentle a touch is used. Others say they prefer to have their partner do the massage, and enjoy sharing the intimate experience.

Perineal massage oils and gels

Massage oils or gels help the massage process by moisturizing the perineal area and making it more elastic. These natural oils have been recommended for perineal massage:

• Vitamin E oil
• Coconut oil
• Sweet almond oil
• Sunflower oil
• Vegetable oils such as olive oil

However, there is some concern that some of these oils might increase the risk of vaginitis and vaginal irritation. Water-soluble lubricants – such as K-Y jelly – are another option, but may irritate vaginal tissues over time. There are also gels made specifically for perineal massage. Ask your healthcare provider for recommendations on what massage oil or gel to use.

How to do perineal massage

Perineal massage isn't difficult to learn. Your midwife or other healthcare provider can show you how. Or you might want to visit a pelvic floor physical therapist a couple of months before your baby is due to learn the method. Some insurance companies will cover this visit. 

You can also learn to do it on your own, following these step-by-step directions (prop a mirror nearby so you can see what you're doing):

1. (Optional) Take a warm bath or shower or use a warm compress on your perineum to increase blood supply and soften the tissues.
2. Make sure your nails are clipped and filed smooth.
3. Wash your hands.
4. Sit comfortably in a semi-reclined position in a quiet place. Lean back on pillows, bend your legs, and spread your knees open.
5. Put a drop or two of oil or gel on your thumbs and perineum.
6. Place your thumbs about 1 to 1½ inches (to or just past your first knuckle) inside your vagina. Press down toward the rectum and toward the sides at the same time. Gently and firmly continue stretching until you feel a slight burn or tingling. (It shouldn't hurt, however.)
7. Hold this position for a minute or two.
8. Now slowly and gently massage the lower part of the vagina back and forth, hooking your thumbs onto the sides of your vagina and gently pulling the tissue forward, as your baby's head will do during delivery. Massage up and down in a U shape (from 9 o'clock to 3 o'clock, if you imagine a clock face), while gently pressing outward. Keep this up for three to four minutes.
9. Finally, massage the tissue that you're holding between your thumb and forefinger back and forth for about a minute.

For partners: Follow the instructions above, but use your index fingers instead of your thumb to massage from one side to the other, gently pressing downward.

Don't:

• Overdo it. A too-vigorous approach could cause bruising or swelling.
• Put pressure on the urethra (urinary opening), as this can lead to irritation or infection.
• Do a perineal massage if you have any type of vaginal infection, such as a yeast infection, a urinary tract infection or genital herpes. Talk with your doctor about treatment first.

Learn more:

You want me to massage what?!?  “Vagina massage” can be extremely beneficial to a woman who needs it. The perineum is the area between the vaginal opening and your butt hole. You may hear about massaging the perineum during third trimester to help soften the tissues and prepare for a vaginal birth. This also may help women who have tight, tense pelvic floor muscles causing pain with sex, incomplete bladder emptying, constipation, vaginal pain/itching/burning, or pain with sitting.

I first learned about perineal massage during my continuing education as it pertains to using it during pregnancy for prevention of tearing during childbirth. It was also discussed in its uses postpartum for healing and working on scar tissue. There is some research on this topic. The evidence is mostly in regards to helping decrease tearing during first time pregnancies. However, the individual feedback I’ve received from clients and the case studies I’ve read lead me to think this is a mostly beneficial exercise to perform during pregnancy and postpartum if it feels right for you. Performing some perineal massage if you’re open to it might be worth considering, as long as you don’t have any precautions surrounding internal work (do your own research and discuss this with any providers you’re working with before beginning).

How does perineal massage help?

Your pelvic floor muscles sit at the base of your pelvis and help support your pelvic organs, hold in pee and poop until you are ready to empty, and have a role in sexual activity and childbirth. However, these muscles are like any other muscles in your body. They can get short and tight and go into spasm. This can cause vaginal penetration to be difficult and sometimes impossible. Pain can also occur with deeper penetration, with orgasm, or even after intercourse is over. These muscles need to be lengthened and relaxed to their normal resting state.

A Pelvic Floor physical therapist can do manual therapy to downtrain and relax those muscles. “Vagina massage” or manual therapy uses a finger pad to apply pressure to a tense or overactive muscle to improve blood flow and relaxation. It can especially be helpful for postpartum women, those who experience pain with sex, or those who have cesarean section scars and perineal tears.

For expecting mothers

For pregnant mamas, there are no negative effects and perineal massage during childbirth has been shown to decrease severity of vaginal tearing. Start around 34-35 weeks and learn how to properly bear down during childbirth to ensure pelvic floor muscle relaxation.  Avoiding breath holding! Perineal massage can also be performed after a vaginal tear or episiotomy. Once the scar is healed, gently massage the area to soften the scar tissue. Postpartum, make sure to be very gentle with your pressure as these tissues are still healing.

How do I do it?

There are several different ways to perform manual therapy on these pelvic floor muscles: with a device called a crystal wand, a therapist or partner can perform, or vaginal dilators (they look like tampons of different sizes) can also help retrain the vaginal wall muscles to relax.

I’ll use a clock face as an example of how to describe a perineal massage as it pertains to the vaginal opening:

• 12:00 being towards the urethra and clitoris

• 6:00 being towards the perineum and anus

Usually instructions are something like below:

1. Insert a clean finger in the vaginal opening towards the 6:00 position.
2. Press down and hold for 30-60 seconds (your goal is to feel a stretch, maybe a little tingling, but not pain greater than 3/10).
3. Move your finger gently towards 3:00 then back to 6:00 then over to 9:00 making a “U” and holding within that region 30-60 seconds in a few different spots.
4. You could also enter a second finger or more and work to spread the vaginal opening wider from 3:00-6:00 and 6:00-9:00 or 3:00-9:00.
5. Perform for a few minutes (~5min), even 1 minute is a great starting place.
6. Perform daily or every other day.

*Helpful tip is that this may feel like a burning/tingling sensation similar to if you hook your fingers around your lips and pull them apart.

My own experience with perineal massage during pregnancy

I can’t remember exactly when I started perineal massage during my pregnancy, but somewhere around 35-36 weeks. My own goal was to mentally feel prepared to expand the tissue in that region when the baby’s head needed to make its way through. I performed it in the shower a few times but found it a bit awkward to reach around and also to remember to do it in that setting. I tried it lying down in bed in a propped position reclined back with pillows and side lying which to me felt more comfortable. I tried it with my fingers, my thumbs and with a dilator from Intimate Rose

I also asked my husband for help once, but turns out I did not enjoy that version and opted to continue solo. I probably only performed the perineal massage 2x per week. Ultimately there was a time near 38-39 weeks that I didn’t want to do it anymore but felt I needed to push the stretch further to almost the size of a fist, so that I could feel more empowered/prepared mentally. I had read about this concept in the book, The Fourth Trimester by Kimberly Ann Johnson. I did that once and then felt I was ready for whatever came my way.

If you have any questions about performing perineal massage during pregnancy or postpartum, schedule an online session with me or one of the other awesome Vagina Whisperer therapists.

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Are you currently pregnant or planning to conceive? If so, make sure to download my FREE resource — 5 Myths We’ve Been Told About Pregnant Bodies!  I correct common pregnancy myths and give you tons of tips to help you feel strong and healthy for 40 weeks and beyond.
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Jen Torborg, PT, DPT, CMTPT, is a pelvic floor physical therapist and author of three Amazon bestselling books: Your Best Pregnancy Ever, Your Best Body after Baby, and Your Pelvic Health. Jen treats clients in Ashland and Bayfield, Wisconsin through Orthopedic & Spine Therapy.

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