Perineal massage is an optional way to gently stretch the tissue around the lower vaginal opening in late pregnancy. The perineum is the skin and muscle between the vaginal opening and the anus. This guide explains when to start and how to keep it gentle and comfortable.
What it may help with
Massage may lower the chance of needing an episiotomy (a surgical cut at the vaginal opening) or stitches after vaginal birth. The evidence is strongest for patients who haven’t had a vaginal birth before. It can also help you get used to the feeling of stretching and relaxing this area.
Massage does not prevent every tear or guarantee a particular birth outcome. Tearing can still happen even with preparation. If you choose not to massage, or you find it uncomfortable, you haven’t done anything wrong.
When to start
Ask your OB team whether massage is right for you. A reasonable starting point is 35 weeks of pregnancy, about three or four times a week for three to five minutes. Start with a shorter session if needed. You don’t need strong pressure, and you don’t need to force a session to last longer.
When to avoid massage
- Don’t massage if you think your water has broken, you have vaginal bleeding, or you have a vaginal infection such as yeast or herpes. Contact your OB team.
- If you have been told to avoid vaginal penetration or are on pelvic rest, do not begin without your OB team’s approval. Ask first about any pregnancy complication or concern about preterm labor.
Get comfortable and prepare
Wash your hands, trim and smooth your nails, and empty your bladder. Lean back with pillows behind you and your knees comfortably bent. A mirror may help you find the vaginal opening. A warm shower beforehand may make you more comfortable.
Use a small amount of unscented water-based lubricant. Avoid products that irritate your skin, and don’t use baby oil, mineral oil, or petroleum jelly. You don’t need a stretching device.
Learn more
RCOG — Reducing your risk of perineal tears
Cambridge University Hospitals — Antenatal perineal massage
How to Perform Perineal Massage
1. Place your thumbs comfortably
Lubricate your thumbs and the lower vaginal opening. Gently insert one or both thumbs only as far as comfortable, up to about two inches (5 cm). Focus on the lower and side walls. Avoid pressure on the urinary opening above the vagina.
2. Apply a gentle stretch
Press gently downward toward the anus and slightly outward to the sides until you feel a mild stretch. Keep your thumbs inside the vagina, not in the anus. Hold the gentle pressure for up to one minute while breathing slowly and letting the muscles soften. Ease off if it’s uncomfortable.
3. Make a slow U-shaped movement
Slowly sweep your thumbs from one lower side of the vaginal opening to the other in a U shape. Continue for another two or three minutes if comfortable, for a total of three to five minutes. Don’t pull hard or force the stretch.
Your comfort comes first
A mild stretching feeling is expected. Sharp pain or strong burning is a reason to stop. You can stop at any time. If a partner helps, they can use clean index fingers and follow your directions about pressure and stopping. Don’t move a finger from the anus back to the vagina without washing it first.
Contact your OB team for bleeding, fluid leakage, contractions, persistent pain, sores, itching, or unusual discharge. If massage is hard for you or brings up distress, it’s okay to skip it and ask us about support or a referral to pelvic floor physical therapy.
Discuss your preferences for birth and recovery
Ask your delivery team about a warm perineal compress and comfortable birth positions. After birth, do not massage a fresh tear, stitches, or an unhealed wound. Wait for confirmed healing and your clinician’s guidance before starting postpartum scar massage.
Contact Us
Mulberry OBGYN
139 Centre St Ph 118, New York NY 10013
646-872-2773 | info@mulberryobgyn.com