Perineal Massage: Treatment, Effect & Risks

Perineal massage is suitable for pregnant women who want to prepare their bodies for childbirth. Massaging the perineal area between the vagina and anus loosens the tissues there and can often prevent an episiotomy or perineal tear and help to improve relaxation during childbirth. Massage can easily be done at home.

What is perineal massage?

Perineal massage is a part of birth preparation and is often recommended by midwives. The goal is to make the area between the vagina and anus more supple. Perineal massage is a part of birth preparation and is often recommended by midwives. The goal is to make the area between the vagina and anus more pliable so that it is less likely to tear during birth. The perineum is subjected to great pressure during childbirth. Regular perineal massage makes the area in question more stretchy due to increased blood flow. A psychological component also resonates: By massaging the perineum, the woman is mentally prepared for the stretching during childbirth, which alleviates the shock in the corresponding situation. In the optimal case, the memory of the massage ritual also helps with relaxation during birth, which facilitates the birth process. The massage can be done easily and independently at home with little time and does not require any tools other than a suitable oil. At the latest 1.5 months before the birth, regular perineal massage should be started – either by the pregnant woman herself or also by her partner.

Function, effect and goals

Perineal massage is intended to help pregnant women prepare their bodies and also their psyches for childbirth. At the latest five, but better six weeks before the birth, regular massage of the perineal area should be started in order to achieve the best possible effect. The aim of this special massage is to make the perineal area more elastic for the birth and to stimulate blood circulation in this area so that the tissue does not tear during the birth process or even have to be incised for medical reasons. Of course, perineal massage is not a guarantee of a complication-free birth, but it significantly reduces the risk of perineal tear or a necessary perineal incision. About five to ten minutes should be invested in perineal massage at least every two days. For the greatest possible relaxation, however, it should not be performed under time pressure. The massage can be performed by the patient or by a partner. A gentle, vegetable oil such as jojoba or almond oil serves as an aid. Lubricating gel is also suitable in a pinch. Special perineal massage oils are also on the market, but are not absolutely necessary. It is important that the woman feels comfortable during the perineal massage, as relaxation is an essential factor in this process. A quiet, familiar room, possibly prepared with candles or similar, can contribute to this, as can a bubble bath before the massage. A comfortable position is also crucial. Most women prefer a semi-sitting position on the bed or sofa, but lying down, squatting or supported standing is also a good way to perform perineal massage. Once a comfortable position is found, a little oil is applied to the cleaned hands. Then the thumb is carefully inserted into the vagina, while the index finger, possibly also the middle finger, massages the outer area of the perineum with gentle circular movements. The outer fingers can massage the perineum – under the spatial idea of a clock – to the level of about three and nine o’clock. The second step is to stretch the vagina downward toward the perineum with the inner thumb. Subsequently, two fingers are introduced for this purpose, which are additionally spread in a third step. If the pregnant woman has difficulty entering the vagina with two fingers, the thumb inserted a little lower can also be used to stretch the lateral-lower vaginal entrance. The resulting pressure should be increased slowly enough so that resistance is felt but no pain is felt. The final step in perineal massage is to use the thumb to gently bulge the perineum outward, especially on the underside. Again, there should be resistance, but no pain. If you are unsure about how to perform the perineal massage, you can ask your midwife for advice.This will be happy to advise a pregnant woman in case of difficulties and be able to give valuable individual tips.

Risks, side effects and dangers

Important when performing a perineal massage are, of course, clean hands and short fingernails, so that the massage can proceed hygienically and without injury. In case of infections in the intimate area, it is better to refrain from perineal massage, otherwise it may aggravate or even spread the infection. A fungal infection, for example, requires treatment by a gynecologist before a pregnant woman can perform perineal massage. Those who already know they are prone to preterm labor should seek advice from a midwife before perineal massage. Incorrect pressure in the perineal area can further promote preterm labor in some women. Many women are simply uncomfortable with perineal massage and self-massage. In such cases, warm, relaxing sitz baths may be a possible alternative. They, too, relax the perineal area and provide better local circulation.