Perineal massage is one of the few birth-preparation practices with solid evidence behind it. The major Cochrane review found that women practising it from late pregnancy were less likely to need stitches and less likely to have an episiotomy, with the clearest benefit for those having their first vaginal birth (Beckmann & Stock, 2013). It's simple, it's free in its most basic form, and most Australian hospital pelvic physiotherapy teams now recommend it routinely.
This is a plain-language guide to doing it well: what it is, when to start, exactly how to do it, what's normal to feel, when to check with your clinician first, and a couple of ways to make it easier in the last few weeks when reaching becomes awkward.
What perineal massage is (and what it does)
The perineum is the area of skin and muscle between the vaginal opening and the anus. During a vaginal birth it stretches a lot as the baby's head is born. Gently massaging it in the weeks before birth increases blood flow to the area and helps the tissue, and you, get used to the sensation of stretch.
What the evidence and the hospital guidance point to:
- A lower chance of needing stitches and of having an episiotomy, most clearly for a first vaginal birth.
- Getting familiar with the stretching, tingling and burning sensations so they're less of a surprise as the baby's head is born.
- A lower chance of ongoing perineal pain after birth.
It isn't a guarantee against tearing, and it's most studied in first-time mothers. But the downsides are minimal and the preparation is worthwhile.
When to start and how often
Start from 34 weeks. That's the timing used across Australian hospital guidance and the trials behind the Cochrane review. It gives roughly six weeks of preparation, the tissue responds well at this stage, and the safety profile is well studied.
Aim for every one to two days, or a couple of times a week if that's more realistic, for about five to ten minutes a session. Consistency matters more than length: short, regular sessions beat occasional long ones. You can do it yourself or your partner can help.
Don't start before 34 weeks unless your clinician has specifically advised it.
Before you start
A few minutes of setup makes the whole thing easier and more comfortable:
- Empty your bladder. Lying down with a full bladder is uncomfortable.
- Clean hands, short nails. The tissue is delicate, so trim nails to avoid scratching.
- Warm the area first. A warm bath beforehand, or a warm compress (a clean face washer) held on the perineum for about ten minutes, softens the tissue and helps you relax.
- Get comfortable and private. Sitting propped up in bed with pillows behind you, or sitting up in a warm bath, both work well.
- Use a mirror the first few times. It helps you get familiar with the area and find the right spot.
- Have your oil ready. A plain, unscented, food-grade oil such as almond, olive or coconut oil, or a water-based lubricant. Try to keep oils on the perineum rather than up inside the vagina, as that can occasionally trigger thrush.
How to do perineal massage, step by step
- Apply oil to your thumbs (or index fingers) and to the perineum.
- Insert one or two thumbs about 3–4 cm into the vagina. The work is shallow, at the perineum itself, not the deeper pelvic floor.
- Press down towards the anus and out to each side until you feel a slight stretch, with a mild tingling, burning or stinging sensation. It should not be painful.
- Hold the stretch for about 60 seconds, then release and rest briefly before repeating.
- Sweep in a gentle "U" shape along the lower half of the vaginal opening, keeping that downward and outward pressure.
- Breathe slowly. Slow belly breaths help the muscles let go and the tissue stretch.
- Continue for five to ten minutes, adding more oil as needed.
If your partner is doing it for you, the same applies, and it matters even more that you guide them on how much pressure feels right. Avoid pressing on the top of the vaginal opening, and keep it gentle, since forceful massage can cause bruising or swelling.
What's normal, and when to stop
A slow stretch with mild tingling, stinging or burning is exactly what you're after, and it usually eases within a minute as the tissue softens. The first few sessions are often the most awkward, partly because the area is new territory and partly because the muscles are still guarding. Sharp pain, or discomfort that builds rather than eases, is the signal to stop and check in with your midwife or physiotherapist.
Combine it with pelvic floor exercises
Perineal massage works best as part of the bigger picture. Australian hospital guidance recommends pairing it with regular pelvic floor exercises through pregnancy, both the gentle strengthening and, just as importantly, learning to fully relax and let go, which is exactly what you'll need to do as your baby's head is born. If pregnancy aches are making positioning tricky, our guide to symphysis pubis dysfunction covers comfortable positions that also work for perineal massage.
If reaching becomes hard late in pregnancy
By 36–38 weeks, reaching past your bump to the perineum can be genuinely awkward, and some people have wrist or hand issues (pregnancy-related carpal tunnel is common) that make sustained thumb pressure uncomfortable. A partner can help, and fingers are usually easiest for them.
If you'd rather keep doing it yourself, a bendable pelvic wand can extend your reach from a comfortable hand position. The technique is the same: a lubricated tip, shallow contact at the perineum, the same gentle downward-and-outward stretch. It isn't pushed deep into the canal. The Intimate Rose Bendable Pelvic Wand from the pelvic wand range at Blossom Pelvic Health is the one suited to this, with a bend point for the angle and a smooth silicone tip. Check with your physiotherapist or midwife before using one in pregnancy.
When to check with your clinician first
Perineal massage is safe for most low-risk pregnancies, but a few situations need individual advice before you start. Speak with your midwife, physiotherapist or obstetrician first if any of these apply:
- Placenta praevia or a low-lying placenta, or any vaginal bleeding in the second half of pregnancy.
- A current vaginal infection such as thrush, herpes or BV, which massage could spread or worsen.
- High blood pressure or pre-eclampsia.
- A shortened cervix, cervical insufficiency, or a history of or threatened preterm labour.
- Any concern about your baby's growth, or if your waters have broken.
For most people the clearance conversation is quick. If there's no specific reason to wait, your clinician will usually be happy for you to go ahead.
After birth
Similar techniques are sometimes used after birth to keep scar tissue mobile if you've had a tear or episiotomy. This is different work, on healing tissue rather than intact tissue, and it's best started with guidance, usually after your six-week check. A bendable wand can help here too, but let your pelvic physiotherapist guide the timing.
What perineal massage doesn't do
- It doesn't guarantee you won't tear. It lowers the likelihood, on average, most clearly for a first vaginal birth. Labour, baby positioning and other clinical factors still play a big part.
- It does less for later births. The strongest evidence is in first vaginal births.
- It doesn't shorten labour. The benefit is about perineal trauma and episiotomy, not labour length.
- It doesn't replace the rest of your preparation. Pelvic floor work and a physiotherapy assessment round out the picture.
A final word
Perineal massage is one of the cleaner findings in birth preparation: a simple, low-risk practice with a real reduction in tearing and stitches for first-time mothers. Do it gently, warm up the tissue first, breathe through the stretch, and check in with your clinician if anything doesn't feel right. If reaching is the main barrier late in pregnancy and you'd like a wand to help, email hello@blossompelvichealth.com.au and we'll help match one to what your midwife or physio has suggested.
References
- Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;(4):CD005123. PMID 23633325
- The Royal Women's Hospital. Practising perineal massage during your pregnancy (fact sheet, 2023).
- Mater Mothers' Hospital. Perineal massage (patient information, reviewed 2024).
- Royal College of Obstetricians and Gynaecologists. Reducing your risk of perineal tears (2024).
- Women's and Children's Health Network SA. Antenatal Perineal Massage (patient brochure, reviewed 2024).
