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Perineal massage

A simple practice that can reduce the risk of tearing

The perineum is the area of skin and muscle between your vagina and anus. During the birth of your baby, the perineum stretches dramatically — and for many women, this leads to tearing or to a surgical cut (episiotomy) being needed.

There’s good evidence that perineal massage in the last weeks of pregnancy can help your perineum stretch more easily, reducing the chance of tearing and the need for stitches. This page explains what it is, why it helps, and how to do it.

What are the advantages of perineal massage?

  • It increases the elasticity (stretchiness) of the perineum.
  • It improves the perineum’s blood flow and ability to stretch more easily and less painfully during the birth.
  • Tears are less likely, and you are less likely to need stitches or an episiotomy.
  • Some women find the practice helpful psychologically — it helps you become familiar with the area and the sensation of stretching, which can reduce fear in labour.

The latest Cochrane systematic review suggests that antenatal perineal massage reduces the likelihood of perineal trauma in first-time mums and perineal pain for second-time mums.

How common is tearing?

40% to 85% of all women who give birth vaginally will tear to some degree. About two-thirds of these women will need stitches. Most tears are minor and heal well.

An episiotomy is a cut to the perineum that is sometimes performed to speed up the birth of your baby or to try to prevent a more severe tear. You may need stitches after birth if you have a tear or have had an episiotomy.

There are many ways your midwife can help reduce your chances of tearing during the birth itself — recommending specific pushing positions, providing gentle pressure on the baby’s head as it comes out, and using warm compresses to your perineum. Perineal massage before the birth adds another layer of preparation that you can do yourself, at home.

How to do perineal massage

If you’d like to try perineal massage, begin around 6 weeks before your due date, and aim to do it most days. Follow these steps:

  1. Wash your hands well, and keep your fingernails short.
  2. Relax in a private place with your knees bent. Some women like to lean on pillows for back support.
  3. Lubricate your thumbs and the perineal tissues. Use a lubricant such as vitamin E oil or almond oil, or any vegetable oil like olive oil. You may also try a water-soluble jelly such as K-Y jelly, or your body’s natural vaginal lubricant. Do not use baby oil, mineral oil or petroleum jelly.
  4. Place your thumbs about 1 to 1.5 inches inside your vagina. Press down (toward the anus) and to the sides until you feel a slight burning, stretching sensation.
  5. Hold that position for 1 or 2 minutes.
  6. With your thumbs, gently and slowly massage the lower half of the vagina, using a U-shaped movement, for a couple of minutes.
  7. Aim for 5–10 minutes a day, several times a week.

It may feel strange at first, and you may feel a stinging or burning sensation initially — this is normal as the tissues stretch. It should not cause sharp pain.

Tips, variations and questions

Can my partner do it?

Yes — your partner can do it for you, using their index fingers rather than thumbs. The technique is the same. Some couples prefer this; others don’t. Whatever feels comfortable for you.

Around 5–10 minutes is enough. Quality matters more than duration.

A gentle stretching, tingling or burning feeling is normal — it’s exactly what you’re aiming for. Sharp pain is not normal — ease off the pressure.

Perineal massage is generally safe right up to labour. Stop if you have any vaginal bleeding, your waters break, or your midwife advises you not to do it (for example, if you have certain infections or placental conditions).

No — but the evidence suggests it reduces the likelihood, particularly for first-time mums. Even if you do tear, regular practice helps you understand the sensation of stretching, which can make pushing feel less unfamiliar.

Warm compresses to the perineum during the pushing phase, certain birthing positions (side-lying, upright, on hands and knees), and gentle, controlled pushing all help reduce severe tearing. Discuss with your midwife.