Perineal Massage: Benefits, Techniques, and Tips

Disclaimer

The information provided in this document is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. It is important to note that everyone is unique, and the information shared in this document may not apply to everyone. The content provided may not constitute a therapist-patient relationship, and it is recommended that you consult with a qualified healthcare professional or licensed physiotherapist for personalized advice tailored to your specific situation.

The Perineum

What are the perineal muscles?

The perineum is an area of the pelvis that run from the pubic bone to the tail bone, and the sit-bone to the sit-bone. There are several perineal muscles in your pelvic floor. They are identified in green in the image. The perineal muscles are part of what can tear during labour and delivery.

Perineal tear grades

There is usually tearing that occurs during childbirth when the vaginal canal is being lengthened. Often these tears are subdivided into 4 types:

Perineal Tears

• Grade 1: Involves tearing the "skin" of the vaginal lining

• Grade 2: Involves tearing the perineal muscles around the vaginal opening

• Grade 3: Involves tears the partially affect the anal sphincter

• Grade 4: Involves tear the tear from the vaginal to the anal lining

  
  
  
  
  
  

What is perineal massage and how can it help?

Definition: A vaginal stretching/massaging strategy to desensitize your pelvic floor muscles to stretch that begins around weeks 34-36 of pregnancy.

Purpose: To prepare the perineum for childbirth by increasing its elasticity and flexibility, and decreasing severe tear outcomes

Benefits:

• Reduced risk of perineal trauma during childbirth

• Decreased likelihood of needing an episiotomy

• Improved perineal elasticity and flexibility

• Potential reduction in postpartum pain and discomfort

---

See a pelvic floor physiotherapist before beginning perineal massage

It is a good idea to see a pelvic floor physiotherapist to teach you how to do perineal massage correctly. You can work with me directly in Little Italy in Toronto by clicking the booking link below, or find someone closer to your area.

Book Prenatal Session at Urban Wellness

---

How to perform perineal massage

1. Wash Your Hands, fingernails should be cut short and clean.

2. Find a Comfortable Position (or a desired pushing position)

3. Place your thumbs or flat index fingers about 1 inch inside the vagina using lubrication.

4. Visualize a clock around the vaginal canal (6 o'clock towards the anus). Press down toward 6 o’clock until you feel a strong stretch (4/10), but NOT pain.

5. Maintain this pressure as you practice relaxation breathing until you no longer feel the discomfort or until you have completed 5 breaths.

6. Move through each point on the bottom half of the clock (not above), and repeat the steps.

7. Progress the massage by gently moving your fingers in a U-shaped motion — From 3 to 9 and 9 to 3.

8. Continue for Several Minutes: 5-10 minutes

Tips and precautions

• Communicate with Your Partner: If you prefer, your partner can perform perineal massage for you. Ensure clear communication and establish comfort levels beforehand.

• Relaxation is Key: Focus on relaxing your body and mind during perineal massage. Take slow, deep breaths and visualize the tissues becoming more flexible and elastic.

• Stop if There's Discomfort: If you experience pain or discomfort during perineal massage, stop and try again later. It's important not to force the massage or cause any injury to the tissues.

• Recommended starting time: Around 34 weeks of pregnancy (variability in current research)

• Do not perform if you have been put on bed rest/told you cannot be sexually active by your healthcare provider.

• Perform no less than 3 times per week

Does it actually help?

Sample of research:

Effect of Prenatal Perineal Massage on Postpartum Perineal Injury and Postpartum Complications: A Meta-Analysis - 2022

• No significant difference in 1-2 degree perineal tearing

• Prenatal perineal massage significantly reduced the incidence of 3-4 degree perineal tears (RR = 0:56, 95% CI [0.47, 0.67])

• Prenatal perineal massage reduced the risk of lateral perineal resection (RR = 0:87, 95% CI [0.80, 0.95])

• Prenatal perineal massage reduced the risk of postpartum pain at 3 months (RR = 0:64, 95% CI [0.51, 0.81])

Perineal Massage for Prevention of Perineal Trauma and Episiotomy During Labor: A Systematic Review and Meta-Analysis - Published 2022

• “Women with perineal massage during labor had a significantly lower incidence of severe perineal trauma (RR: 0.52, 95% CI 0.29- 0.94) compared to the control group.”

Perineal massage and warm compresses – Randomised controlled trial for reduce perineal trauma during labor - 2023

• The incidence of intact perineum was significantly higher in the perineal massage and warm compresses group [perineal massage and warm compresses group: 47% vs control group: 26.3%; OR 2.53, 95% CI 1.86–3.45, p<0.001]”

• The perineal massage and warm compresses technique increased the incidence of intact periineum and reduced the incidence of second-degree tear, episiotomy and obstetric anal sphincter injury

Book Your Appointment Today!

As a pelvic floor physiotherapist in Little Italy, Toronto, I offer specialized treatments and exercises for pregnancy. If you’re in the College and Bathurst area of Toronto and need professional guidance, don’t hesitate to reach out. Book an appointment today and let’s work together towards your goals!

By Maja Degen, your trusted pelvic floor physiotherapist in Little Italy, Toronto. Schedule an appointment directly.