Perineal massage is a simple stretching technique you do in the final weeks of pregnancy to help the tissue between your vagina and anus become more flexible for birth. A Cochrane review of four trials involving 2,480 women found that regular prenatal perineal massage reduced the likelihood of needing an episiotomy by 16% and lowered the overall rate of tearing that required stitches. These benefits were significant for first-time mothers specifically.
The technique takes about five minutes per session, requires no special equipment, and can be done by you or a partner. Here’s exactly how to do it.
When to Start and How Often
Begin at week 34 of your pregnancy. Massage your perineum three to four times per week for about five minutes per session. You don’t need to do it daily, and there’s no benefit to starting much earlier than 34 weeks. Consistency matters more than frequency: spreading sessions across the week gives tissue time to recover between stretches.
Preparation Before You Begin
A warm bath or shower beforehand softens the perineal tissue and makes the massage more comfortable. Empty your bladder first so you can relax fully without pressure or distraction.
Wash your hands thoroughly and make sure your nails (or your partner’s nails) are trimmed short. Even slightly long nails can scratch the delicate skin around the perineum and cause micro-tears that invite infection.
You’ll need a lubricant. Good options include natural oils like organic sunflower, grapeseed, coconut, almond, or olive oil. Water-soluble personal lubricants also work well. Avoid synthetic oils such as baby oil, mineral oil, or petroleum jelly, which can irritate vaginal tissue.
Finding a Comfortable Position
If you’re doing this yourself, try sitting propped up against pillows with your knees bent and legs relaxed apart. Some people prefer a semi-reclined position on the bed or sitting on the toilet. The goal is to reach your perineum comfortably without straining. Experiment with positions until you find one that lets your shoulders and legs stay relaxed.
If a partner is helping, you can lie back with your knees bent while they sit facing you. A partner uses their index fingers instead of thumbs, applying the same movements described below.
Step-by-Step Technique
Apply a generous amount of lubricant to your thumbs and around the perineal area. Insert your lubricated thumb or thumbs about 3 to 4 centimeters (roughly 1.5 inches) inside your vagina, resting them against the back wall, which is the side closest to your anus.
Press downward toward your anus and then sweep to the sides in a U-shaped motion. Think of a clock face: you’re moving from the 6 o’clock position out to 3 o’clock on the right side, and from 6 o’clock out to 9 o’clock on the left side. Keep steady, firm pressure as you slowly move your thumbs back and forth along this U shape. You’re stretching the tissue, not rubbing it.
Hold the stretch at each point for a few seconds before moving to the next position along the U. The entire massage should take four to five minutes. You don’t need to rush through it or repeat it beyond that window.
What It Should Feel Like
During the first couple of weeks, you’ll likely feel a slight burning or stretching sensation. This is normal and actually a useful part of the process. That same burning feeling occurs during the final stage of labor when the baby’s head stretches the perineum, sometimes called the “ring of fire.” Experiencing it in advance gives you a chance to practice breathing through it, which many women say helps them stay calmer and more confident during delivery.
The massage should never be painful. If it hurts, you’re pressing too hard or the tissue needs more lubricant. As you practice over several weeks, the tissue will become noticeably more flexible and the stretching sensation will lessen.
What Perineal Massage Does and Doesn’t Prevent
The strongest evidence supports perineal massage for reducing episiotomies in first-time mothers. In the Cochrane review, roughly 1 in every 15 women who practiced massage avoided tearing that would have needed stitches. Those are meaningful odds for a technique that’s free and takes five minutes.
However, perineal massage did not reduce the rate of minor first- or second-degree tears, and it didn’t change the incidence of severe third- or fourth-degree tears. It also showed no significant benefit for women who had already given birth vaginally before, likely because their tissue had already stretched during a previous delivery.
When to Skip It
Do not perform perineal massage if you have an active vaginal infection such as thrush, a urinary tract infection, or a genital herpes outbreak. Massaging inflamed or infected tissue can worsen the condition or spread infection. If your obstetric team has advised against it for any reason specific to your pregnancy, follow their guidance. Once the infection clears, you can start or resume the massage.
Tips for Making It Easier
- Use a mirror at first. Seeing what you’re doing helps you orient finger placement, especially if you’ve never touched or examined your perineum before.
- Warm the oil. Rubbing oil between your hands for a few seconds before applying it makes the initial contact less jarring.
- Breathe slowly. Deep, steady breathing helps your pelvic floor muscles relax, which makes the stretch more effective and less uncomfortable.
- Be patient with the first few sessions. The tissue is tight initially, and the sensation is unfamiliar. Most people find it noticeably easier by the third or fourth session.
- Don’t press upward. All pressure should go toward the back wall of the vagina (toward the anus) and to the sides. Pressing upward toward the urethra serves no purpose and can cause discomfort.