How to do perineal massage: a step-by-step guide

Research shows perineal massage in the third trimester is likely to reduce your chances of perineal trauma (Abdelhakim et al, 2020). What’s more, most mums-to-be who tried perineal massage felt comfortable and positive about their experience. They said they’d do it again in another pregnancy and would recommend it to others (Labrecque et al, 2001).

The perineum is the skin and muscle between vagina and anus. You can massage your perineum by yourself, or with your partner if you’d prefer.

Perineal massage aims to stretch, usually using two fingers, the perineal tissues ready for birth.

You can start practising perineal massage whenever you like, and many women will start during the third trimester. Avoid perineal massage if you have vaginal herpes, thrush or a vaginal infection (Oxford University NHS Trust, 2014). Here’s what you’ll need:

1. Be prepared

• Wash your hands thoroughly and make sure your or your partner’s (if they’re helping) fingernails are short.
• Find somewhere you can relax, uninterrupted and in privacy with your legs open wide and your knees bent.
• Make sure you have your chosen oil and your mirror handy if you need it.

2. Find a comfy position for you

You could try:

• being propped up with pillows on a bed or sofa so you or your partner can reach your perineum more easily
• reclining in the bath with one leg up on the side at a time
• standing in a warm shower with one leg up on a stool before you change legs
• sitting on the toilet.

3. Lubricate your perineum

Put some oil on your perineum and the lower part of your vaginal opening. This helps to make the massage more comfortable.

4. Relax and start the massage

Taking some deep breaths might help you relax.

1. Put your thumbs about 2.5cm to 4cm just inside the back wall of your vagina. You might find it easier to use a mirror the first few times.
2. Press down towards your anus and to the sides. You should feel a bit of a stretching feeling.
3. Hold this stretch for about one to two minutes.
4. Then gently massage the lower bit of your vagina for around two to three minutes, focusing on relaxing your perineum. Massage using your thumbs upwards and outwards then back again in a U-shaped movement. You could practice your slow, deep breathing techniques while you do this.  (RCOG, no date) Repeat this two to three times (RCOG, no date). 
5. Some people will focus the massage on any previous scar tissue.

Perineal massage shouldn’t hurt, though you may feel pressure in the first few weeks of starting, which should ease.

5. Partner involvement

• It can be difficult to massage your perineum by yourself in the later stages of pregnancy.
• You might want to start off doing the perineal massage yourself. Then as you get nearer to the due date, if you feel comfortable doing so you could ask your partner to do it.
• Simply follow the same method as before. The only difference is that your partner will use their index fingers rather than thumbs to perform side-to-side and U-shaped downward pressure.

6. Keep up the routine

• Repeat daily or when possible.
• Fit it into your daily or weekly routine, for example during or after a bath or shower. This is a good time because blood vessels in the area are already dilated, making the perineum softer and more comfortable to massage. You will also be more relaxed.

7. Support is available

Perineal massage shouldn’t be painful although there might be some discomfort to begin with. If you’re concerned about any pain, or you need further information or support with perineal massage, talk to your midwife or GP.