If the thought of perineal massage makes you feel a little awkward, you're definitely not alone.
Perineal massage is one of those things that many people hear about in late pregnancy, but aren't quite sure what it is, whether it's worth doing, or how to get started. The good news is that research suggests perineal massage may help reduce the risk of severe perineal tearing and the need for an episiotomy, particularly in a first vaginal birth. Let's break down what it is, who it might help, and how to get started.
What is perineal massage?
Perineal massage involves gently stretching and massaging the tissues at the entrance of the vagina in the weeks leading up to birth.
It’s typically recommended from around 34–36 weeks of pregnancy for people planning a vaginal delivery.
The aim is to help improve your awareness of the tissues, become familiar with the sensation of stretching, and potentially improve the flexibility of the perineum before birth.
Evidence suggests that perineal massage in a first vaginal birth can significantly reduce the risk of severe perineal tearing and the need for episiotomy.
What is the perineum and why is it important during birth?
The perineum is the skin and tissue between the vagina and anus.
During a vaginal birth, these tissues need to stretch significantly as the baby’s head is born. Often, when this process is slow and controlled, the tissues adapt well to the stretch.
However, factors such as a larger baby, a smaller perineum, a faster birth, or the use of instruments can increase the risk of perineal injury.
It’s important to remember that while perineal massage may reduce the risk of more significant tearing, it cannot completely prevent tears from occurring.
How do you perform perineal massage?
Perineal massage is usually started at 34–36 weeks of pregnancy, around 2–3 times per week. Research suggests that aiming for approximately seven sessions before labour may be enough to provide benefit.
First of all, get relaxed and comfortable! If you usually use a vaginal lubricant, you might like to use one here too (but make sure it’s natural, we have a lot of great ones we highly recommend!).
Then, a clean thumb or finger is placed approximately 2cm inside the vagina before applying gentle pressure downwards towards the anus.
There are a few different approaches that can be used:
Sustained stretching of the tissues;
Gentle massage of the tissues; or,
A combination of both techniques
The goal isn’t to cause pain. Most people describe the sensation as a strong stretch rather than discomfort. If the area feels particularly sensitive, techniques can be modified and progressed gradually over time.
Can my birth partner help with perineal massage?
Absolutely.
Many people choose to perform perineal massage themselves, while others prefer their partner to help. Some find it easier physically, particularly later in pregnancy when reaching the area becomes more difficult.
If your birth partner will be supporting you through labour and birth, involving them in the process can also help them better understand your body, your comfort levels, and how they can support you throughout the pregnancy journey.
At The Healthy Peach Physio, your birth partner is more than welcome to attend your appointment. We can teach both of you how to perform perineal massage safely, answer any questions, and guide you through the technique together. Many couples find that having hands-on guidance helps take away some of the uncertainty and makes the process feel far less intimidating.
Who should avoid perineal massage?
Perineal massage is generally considered safe for most people in late pregnancy, however it may not be appropriate if you have: a low-lying placenta (placenta previa), vaginal bleeding, a shortened cervix, a vaginal infection such as herpes or thrush or certain high blood pressure conditions during pregnancy.
If you’re unsure whether perineal massage is suitable for you, speak with your healthcare team before getting started.
It’s also about getting in touch with your body!
There is no way to completely eliminate the risk of tearing during childbirth, but perineal massage is one of the few things we can do during pregnancy that may help prepare the tissues for birth.
Like many aspects of birth preparation, it’s less about doing it perfectly and more about becoming familiar with your body, understanding what stretching feels like, and giving yourself another tool to support your labour and birth experience.
If you’re not sure where to start, a pelvic floor physiotherapist can guide you through the process and tailor the approach to your comfort level and individual circumstances.
References:
Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev 2013;4:CD005123. doi: 10.1002/14651858.CD005123.pub3.
Chen Q, Qiu X, Fu A, Han Y. Effect of Prenatal Perineal Massage on Postpartum Perineal Injury and Postpartum Complications: A Meta-Analysis. Comput Math Methods Med. 2022 Jul 14;2022:3315638. doi: 10.1155/2022/3315638. PMID: 35872935; PMCID: PMC9303122.
Zhang J, Cai F, Li Y, Xu M. Impact and safety of perineal massage in late pregnancy on delivery outcomes among primiparous women: a propensity score matching analysis. BMC Pregnancy Childbirth. 2025 Nov 26;25(1):1270. doi: 10.1186/s12884-025-08452-9. PMID: 41299371; PMCID: PMC12659469.
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