How to do a Perineal Massage

Perineal massage is a gentle technique of manually stretching the perineal tissue from week 34 of pregnancy to prepare it for birth. Practised for 5 - 10 minutes, 3 - 4 times per week, it has been shown to reduce the risk of perineal tearing and the need for an episiotomy during delivery - particularly for first-time mothers.

The idea of perineal massage can feel a little daunting at first. But understanding the evidence behind it and learning the correct technique, makes it a straightforward and genuinely useful part of birth preparation, especially if this is your first baby.

What Is Perineal Massage?

The perineum is the area of skin and muscle between the vagina and anus. During birth, this tissue needs to stretch significantly to allow the baby to pass through. Perineal massage involves gently stretching this tissue during the final weeks of pregnancy to increase its elasticity and prepare it for that stretch.

It is done from 34 weeks of pregnancy onwards, during pregnancy only. It is not used after birth.

Does Perineal Massage Reduce Tearing?

Yes. Multiple systematic reviews and randomised controlled trials show that perineal massage from week 34 of pregnancy reduces the likelihood of perineal trauma during birth. The research (Beckmann and Stock, Cochrane Review 2013; Abdelhakim et al, International Urogynecology Journal 2020) specifically shows:

• A reduced likelihood of needing an episiotomy
• Lower rates of perineal tearing requiring stitches in first-time mothers
• Reduced postnatal perineal pain
• The massage also helps you become familiar with the sensation of stretching pressure, which can reduce anxiety about crowning during labour

The benefit is most pronounced for women having their first baby. For those who have given birth vaginally before, perineal massage is still beneficial but the effect is somewhat smaller.

When Should You Start Perineal Massage?

Start at 34 weeks of pregnancy. The benefits are most significant when practised in the final 4 - 6 weeks before your due date, this is when the tissue is most responsive to the stretching and when the proximity to birth means the preparation is most relevant.

If you are past 34 weeks and have not started yet, it is not too late. Starting at 36 or even 38 weeks is still worthwhile. Begin as soon as you feel ready.

Do not perform perineal massage if you have a low-lying placenta, active vaginal infection, unexplained vaginal bleeding or have been advised against it by your midwife.

How to Do Perineal Massage: Step-by-Step

1. Wash your hands thoroughly. Trim nails short to avoid catching sensitive skin.
2. Find a comfortable position. Lying propped up on pillows, sitting up in the bath, or with one foot raised on the edge of the bath. Whatever allows you to reach the area comfortably.
3. Apply a generous amount of massage oil to your thumbs and the perineal area.
4. Place both thumbs approximately 3 - 4 cm inside the vaginal opening, pointing downward.
5. Press gently downward and to the sides, applying steady but gentle pressure.
6. Hold for 1 - 2 minutes until you feel a stretching sensation. This should feel like pressure, not pain. If it is sharply painful, ease off.
7. Slowly sweep both thumbs in a U-shaped motion from side to side for 1 - 2 minutes.
8. Practise for 5 - 10 minutes total.
9. Repeat 3- 4 times per week from week 34 until birth.

The stretching sensation will become more familiar and more comfortable over time. Most women notice significantly more elasticity and less discomfort after 2 - 3 weeks of regular massage.

Best Oils for Perineal Massage

A natural, unscented oil with good skin absorption is ideal. Suitable options include:

• Sweet almond oil: lightweight, widely recommended, skin-softening
• Jojoba oil: closely mimics the skin's natural oils, absorbs well
• Avocado oil: rich in fatty acids that support skin elasticity
• Evening primrose oil:  traditionally associated with skin suppleness
• Purpose-blended perineal massage oils: combine multiple beneficial carrier oils with ingredients specifically chosen to improve skin elasticity

Avoid mineral oils, heavily fragranced products and any oil you have a known sensitivity to. Water-based lubricants are not suitable - they evaporate too quickly and do not provide sufficient lubrication for the massage.

How Often Should You Do Perineal Massage?

Practise 3 - 4 times per week from week 34 until birth. Daily practice is fine and may produce slightly better outcomes, but 3 - 4 times per week is the standard recommendation supported by research. Each session should last 5 - 10 minutes.

Consistency matters more than frequency. A regular routine of 3 - 4 times weekly is more effective than daily sessions done sporadically.

Can a Partner Help With Perineal Massage?

Yes, and many women find this easier in the later weeks of pregnancy when reaching becomes difficult. A partner uses clean index fingers rather than thumbs, follows the same technique, and applies the same downward and U-shaped pressure.

Communication is the most important part of a partner-assisted massage. Agree on a signal to ease off, maintain steady communication about pressure, and stop immediately if you feel sharp discomfort rather than the expected stretching sensation.

Frequently Asked Questions About Perineal Massage

Does perineal massage actually work?

Yes. Research published in peer-reviewed obstetric journals shows that perineal massage from week 34 reduces the likelihood of perineal trauma during birth, particularly for first-time mothers. It is associated with reduced postnatal perineal pain and a lower rate of episiotomy.

When should you start perineal massage?

Most midwives recommend starting from week 34 of pregnancy. The benefits are most significant in the final 4–6 weeks before your due date. Starting later is still worthwhile — begin as soon as you feel ready.

How do you do perineal massage step by step?

With clean hands and massage oil, place thumbs 3 - 4 cm inside the vaginal opening. Press gently downward and outward, holding for 1 - 2 minutes until you feel a stretching sensation. Sweep slowly in a U-shape for 1 - 2 minutes. Practise for 5 - 10 minutes total, 3 - 4 times per week from week 34.

What oil should you use for perineal massage?

The best oils are pure, natural carrier oils such as sweet almond, jojoba, avocado or evening primrose oil. Avoid mineral oils, heavily fragranced products and water-based lubricants. Purpose-blended perineal massage oils combine multiple beneficial oils in a formulation designed for this use.

Can my partner do perineal massage for me?

Yes. A partner uses clean index fingers and follows the same downward and U-shaped technique. Clear communication about pressure and comfort is essential — stop immediately if you feel sharp pain rather than the expected stretching sensation.

Also useful before birth: our guide to perineal care after birth, tears and stitches, and what to include in your postpartum care kit.