The best options for perineal massage are unscented plant-based oils or a water-based personal lubricant. Natural oils like sunflower, sweet almond, coconut, olive, and grapeseed oil all work well and are considered safe for internal use. If you prefer not to use oil, a water-based lubricant like K-Y Jelly is equally effective. Your body’s own vaginal lubrication is also fine if that feels more comfortable.
Plant-Based Oils That Work Well
Any of these unscented, organic plant-based oils are safe choices:
- Sweet almond oil, one of the most commonly recommended options in clinical guidelines
- Sunflower oil, lightweight and easy to find
- Coconut oil, stays slippery longer due to its thicker consistency
- Olive oil, a pantry staple that works perfectly well
- Grapeseed oil, lighter and less greasy than olive oil
- Jojoba oil, closely mimics the skin’s natural oils
- Vitamin E oil, sometimes used on its own or blended with a carrier oil
The choice between them comes down to personal preference. Some people find thicker oils like coconut more comfortable because they don’t dry out as quickly. Others prefer a lighter oil like grapeseed. What matters most is that the oil lets your fingers glide smoothly over the perineal tissue so you can maintain the stretch long enough for it to be effective.
Water-Based Lubricants as an Alternative
A fragrance-free, toxin-free water-based lubricant is just as effective as plant-based oil. Pelvic floor physical therapists often recommend water-based lubes because they’re less likely to cause irritation for people with sensitive skin. They also wash out of fabric more easily, which is a practical bonus.
The one downside is that water-based lubricants can dry out faster during the massage. If that happens, just reapply. The goal is keeping enough lubrication present so you can hold the stretching pressure for the full session without friction or discomfort.
What to Avoid
Several common household products are not safe for perineal massage, even though they might seem like obvious choices. Do not use baby oil, mineral oil, or petroleum jelly (like Vaseline). These synthetic products can trap bacteria, increase infection risk, and irritate the delicate vaginal tissue. Also avoid any scented oils, lotions, or massage products. Fragrances contain chemicals that can cause irritation or allergic reactions when applied internally.
How to Do the Massage
Start by washing your hands thoroughly and trimming your nails short. Apply your chosen oil or lubricant generously to your thumbs and the perineal area (the skin between your vaginal opening and anus).
Insert one or both thumbs about 3 to 4 centimeters (roughly 1 to 1.5 inches) inside the vagina. Press downward toward your anus and out to the sides, tracing a U-shape. Think of a clock face: you’re sweeping from the 3 o’clock position down through 6 o’clock and over to 9 o’clock. Stretch the tissue open until you feel a tingling or burning sensation. Pause there, take a deep breath, and hold the pressure while slowly moving your thumbs side to side in that same U-shape.
The stretching sensation should feel intense but not painful. If it hurts, ease off slightly. Each session should last up to 5 minutes, and you only need to do it once or twice a week. More frequent than that isn’t recommended.
When to Start
Most people begin perineal massage around week 34 or 35 of pregnancy and continue until delivery. Starting earlier than 34 weeks is not recommended, as the clinical trials supporting this practice all began at that point or later.
A Cochrane review of four trials involving 2,480 women found that those who practiced perineal massage were 16% less likely to have an episiotomy. This benefit was significant only for first-time mothers. The review did not find a reduction in naturally occurring tears, but avoiding an episiotomy is a meaningful outcome on its own, as it can affect recovery time and comfort after birth.
When to Skip It
Perineal massage is not appropriate in every pregnancy. You should avoid it if you have an active vaginal infection such as herpes or thrush, placenta previa or any vaginal bleeding in the second half of pregnancy, cervical shortening, or severe blood pressure problems during pregnancy. If any of these apply, the massage could worsen the condition or introduce additional risk.