How and Why I LOVE Perineal Massage

If you're pregnant and someone has told you to start doing perineal massage, you may have had one of two reactions: “Okay, tell me exactly how to do that,” or “I'm sorry…you want me to put WHAT where?”

I get it. Perineal massage probably isn't at the top of your list of fun pregnancy activities. But as a pelvic floor physical therapist who specializes in pregnancy, birth prep, and postpartum recovery, it is one of the things I actually love teaching my patients.

And yes, I did it during both of my pregnancies. I also did not tear during either of my births.

But before you hear that and think, “Great! So if I do this, I won't tear,” let's pump the brakes. There is no way to guarantee that you will not tear during birth. Birth is complicated, and there are many factors that influence perineal trauma, including baby's position, the speed of birth, whether instruments are needed, your individual anatomy, and whether this is your first vaginal birth.

What I do want you to know is that there is research supporting perineal massage as one tool that may reduce the risk or severity of perineal trauma. And honestly, I think there is another really important benefit: it teaches you to connect with your body and practice relaxing through the sensation of stretch.

What Is Perineal Massage?

Your perineum is the area of tissue between your vaginal opening and your anus. During a vaginal birth, this tissue needs to stretch significantly to allow your baby's head and body to pass through.

Perineal massage involves gently massaging and stretching the tissues around the vaginal opening during the final weeks of pregnancy. The goal is NOT to aggressively “stretch out” your vagina or make your pelvic floor as loose as possible.

You also will not recreate the stretch of a baby's head with your fingers. You can't—and you don't need to.

Instead, think of perineal massage as an introduction. You're introducing your tissues to the sensation of pressure and stretch while also practicing how to breathe and relax through that sensation.

Does Perineal Massage Actually Reduce Tearing?

This is where I want to be careful with the language because you will see a lot of claims online that perineal massage “prevents tearing.”

It doesn't.

A Cochrane review found that antenatal perineal massage was associated with a reduction in perineal trauma requiring stitches and a reduction in episiotomy, particularly for women having their first vaginal birth. More recent research has also found encouraging results regarding severe tears.

A 2022 systematic review and meta-analysis found a lower incidence of third- and fourth-degree tears among women who performed antenatal perineal massage.

So yes, there is evidence that perineal massage may decrease your risk of more significant perineal trauma. But it does not eliminate the possibility of tearing.

And I think that distinction is really important. If you tear during birth, that does NOT mean you didn't prepare enough. You can do everything “right” and still tear. Birth is not a test you pass or fail.

Why I LOVE Perineal Massage

The research around tearing is one reason I teach perineal massage, but it isn't actually the only reason I love it.

I love that it gives you an opportunity to learn what stretching feels like.

Think about how much of pregnancy involves being told what your body will feel like during birth. You'll hear about pressure, stretching, the ring of fire, and all the other lovely ways people describe the sensations of pushing.

Perineal massage gives you a chance to experience a small version of that stretch before you're in labor.

Again, your fingers are NOT creating the same stretch your baby will. But you can learn how your body responds when you feel pressure. Do you hold your breath? Do you clench your pelvic floor? Do your glutes tighten? Can you relax your jaw and take a slow breath?

This is useful information.

Your pelvic floor isn't just a muscle that needs to be strong. It needs to be able to contract, relax, and lengthen. During a vaginal birth, your pelvic floor needs to accommodate your baby's movement through your pelvis and vaginal canal.

That is one reason I love pelvic floor physical therapy as part of birth prep. We aren't just talking about Kegels. We're looking at your breathing, your pelvic floor, your hips, your mobility, your birth positions, and your ability to relax and work with your body.

When Should You Start?

Most recommendations for antenatal perineal massage place it in the final weeks of pregnancy. The Royal College of Obstetricians and Gynaecologists recommends considering it from around 35 weeks.

For my patients, I generally like starting around the third trimester, assuming there isn't a medical reason you've been told to avoid it.

And please don't feel like you need to do this every single night for 30 minutes. Pregnancy already comes with enough things on the to-do list.

I typically recommend about 5–10 minutes, 1–4 times per week. Some research protocols and clinical resources use more frequent massage, so there isn't one magic number. The goal is to make this a realistic part of your birth prep rather than another thing you feel like you have to do perfectly.

How Do You Perform Perineal Massage?

Perineal massage can be performed yourself or with the help of your partner. You'll want to find a comfortable position where you can reach the area without straining. Some people prefer lying back with their legs supported, while others find standing with one leg supported more comfortable.

Using clean hands and trimmed nails, apply a small amount of comfortable lubricant to your thumbs or fingers. Gently insert your thumbs just inside the vaginal opening and apply pressure down toward the rectum and slightly out toward the sides.

You should feel stretching or pressure, not sharp pain.

This is where the breathing comes in. Rather than bracing against the stretch, take slow breaths and consciously try to relax your pelvic floor. You can gently massage along the lower portion of the vaginal opening while allowing the tissue to gradually soften.

More pressure does not equal more benefit. You are not trying to aggressively stretch the tissue. You're practicing stretch + breathing + relaxation.

If you're struggling with positioning or reaching the area because your belly is now approximately the size of a small planet, you're not alone. Your partner can help, or a pelvic floor physical therapist can walk you through the technique.

Perineal Massage Is Only One Piece of Birth Prep

I love perineal massage, but I don't want you to think it's your entire strategy for reducing tearing.

There are other factors during labor and birth that may influence perineal trauma. Research and clinical guidance have looked at things such as birth position, warm compresses, controlled delivery of the baby's head, and perineal support during birth.

This is why I love looking at birth prep as a bigger picture.

We want to talk about your pelvic floor, but we also want to talk about breathing, pushing, movement, positioning, and how your baby's position interacts with your pelvis.

Birth is movement. Your baby is moving through your pelvis, your pelvis can move, and your pelvic floor needs to respond to all of it.

So…Should You Do It?

If you're approaching the third trimester and planning a vaginal birth, perineal massage is one evidence-based tool you can consider adding to your birth prep. Research suggests it may reduce perineal trauma and may reduce the risk of more severe third- and fourth-degree tears, although it absolutely does not guarantee that you won't tear.

For me, though, the biggest benefit goes beyond the research.

I love that perineal massage gives you a few minutes to connect with your body. It gives you the opportunity to feel what stretching feels like, notice how your pelvic floor responds, and practice breathing and relaxing when you feel pressure.

I did perineal massage during both of my pregnancies, and I didn't tear during either birth. But I would never tell you that perineal massage is the reason I didn't tear. That's not what the research allows us to say.

Instead, I think of it as one small piece of a much bigger picture.

You don't need to prepare for birth perfectly. You need good information, practical tools, and a better understanding of how your body can work with the process.

And that's exactly what I want birth prep to give you.

If you're in Kansas City or Lee's Summit and want individualized pelvic floor therapy or pelvic floor physical therapy during pregnancy, enCORE Therapy can help you prepare for birth with an approach that goes beyond Kegels and generic birth advice.

Want the step-by-step version?

I've created a FREE Perineal Massage Handout that walks you through exactly how to perform perineal massage, including positioning, technique, and what you should—and shouldn't—feel.

Your body doesn't need to be forced into preparing for birth. It deserves to be understood, supported, and prepared.