Perineal massage during pregnancy: How to do it and benefits

During pregnancy, labor, and delivery, there’s a lot that can feel outside of your control. Finding things you can practice ahead of time can feel grounding and empowering.

Perineal massage is one option. Your perineum — the tissue between your vaginal opening and anus — is designed to stretch a lot as your baby is born. During late pregnancy, regularly and gently stretching this area with perineal massage may help it get used to the pressure and stretching experienced during vaginal delivery. 

Perineal massage may lower the risk of significant tearing and support a smoother recovery afterward, especially in a first pregnancy. With gradual practice, many people find that perineal massage helps the area feel more familiar and easier to relax during labor.

“You’re giving those tissues a chance to experience gentle stretching in a calm, supported way,” says Martha Barker, PT, DPT, a Hinge Health physical therapist. “Over time, that can help the area feel more adaptable.”

You can usually do perineal massage yourself without special equipment. In the third trimester, perineal massage is generally considered safe for many pregnant people. It’s straightforward to learn, and even a few short sessions a week may be helpful.

In this article, learn more about perineal massage during pregnancy — what it is, potential benefits, when to start, and how to do it — with guidance from Hinge Health pelvic floor therapists.

What is perineal massage?

Perineal massage is a technique that involves gently stretching the perineum — the tissue between the vaginal opening and anus.

“The goal is to help the tissue get used to stretching and pressure, and to support comfortable blood flow to the area before birth,” says Dr. Barker.

Perineal massage has been studied in clinical research and is associated with a lower risk of certain types of perineal tearing, particularly for people giving birth vaginally for the first time.

It’s common for perineal massage to feel new, awkward, or a bit uncomfortable in the beginning. Using relaxation strategies, like diaphragmatic breathing, can help calm your nervous system and let the tissue slowly lengthen without forcing it.

Benefits of perineal massage during pregnancy

Studies show several potential benefits of perineal massage during pregnancy. While every body and every birth are different, perineal massage may help with:

• Lower risk of more severe tears. Perineal massage is associated with a reduced likelihood of deeper (third- and fourth-degree) perineal tears, especially in first-time vaginal births.

• Less need for episiotomy. Perineal massage may decrease the chances of needing an episiotomy (a surgical cut in the perineum that is repaired with stitches), which can make recovery feel easier for some people.

• More familiarity with birth sensations. During birth, your pelvic floor needs to relax and lengthen — similar to when you have a bowel movement or urinate. Practicing gentle perineal stretching ahead of time can make the sensations of pressure and stretch feel less surprising, which may reduce fear and tension in labor.

• Improved blood flow and tissue health. Stimulating the perineal tissue can increase circulation in the area, which supports tissue health and its natural capacity to heal after birth.

• Potential for less postpartum discomfort. Because perineal massage is linked with fewer severe tears, some people also report less pain and an easier recovery after delivery.

While the benefits appear strongest in first pregnancies, Dr. Barker notes that perineal massage can still be a useful practice for subsequent pregnancies, too.

When to start perineal massage in pregnancy

Your perineal tissue, like other tissues in your body, responds to gradual change over time. It needs some time to adapt to new stretching, but starting too early isn’t necessary and can feel uncomfortable before your baby is more engaged in the pelvis.

If you’re wondering when to start perineal massage during pregnancy, most guidance recommends beginning around 35 weeks of pregnancy, or the beginning of the ninth month.

“You can start earlier if you’d like to practice the steps,” says Dr. Barker. “But we don’t have much data showing that starting well before the last month makes a meaningful difference.”

It’s also not “too late” if you’re closer to your due date. Beginning at 37 or 38 weeks can still be helpful.

A practical starting point: aim for three to four sessions per week, for about five to 10 minutes each time. You can adjust the duration and frequency based on how your body responds. Consistent, gentle practice tends to be more effective than occasional, longer sessions.

How to do perineal massage in pregnancy

Most people can learn perineal massage and adapt the technique to what feels manageable in their own body. As you get started, focus on setting up your space and body so you can relax as much as possible.

1. Preparation

• Wash your hands. 

• Keep lubricant nearby if you’d like to use it. This can make the massage feel smoother and more comfortable.

• Find a position where your body can let go of tension. Many people like lying propped up with pillows behind them, or lying on their side with knees bent.

• Take a moment to “downshift” your nervous system — maybe with a few slow breaths, dimmer lights, or calming music.

“You want to feel supported and as relaxed as you reasonably can so your pelvic floor has a chance to lengthen and soften,” says Dr. Barker.

2. Technique

• Start with several slow, deep breaths, letting your belly and rib cage gently expand as you inhale and soften as you exhale.

• With clean, lubricated thumbs, gently insert them about 3–4 cm into the vagina.

• Apply firm but tolerable downward and slightly sideways pressure toward the rectum and the sides of the vaginal opening.

• Hold this gentle stretch for about 1–2 minutes while you continue breathing deeply.

• Then slowly move your thumbs in a U-shape, sweeping along the bottom half of the vaginal opening, staying within your comfort zone.

You can always use less pressure or take breaks. The goal is steady, tolerable stretch, not pushing through sharp pain. It can be helpful to start shallow, and go deeper as you build confidence and comfort over time. 

3. Comfort tips

Anything that helps your pelvic floor relax can make perineal massage more comfortable:

• Exhale or add a gentle sigh as you apply pressure.

• Visualize the pelvic floor “melting” or “widening” with each out-breath.

• If you notice a spot that feels sharper or more intense, back off the pressure, breathe there, and return later if it feels okay.

Tips for successful perineal massage

Using perineal massage during the third trimester can be one more tool that prepares both your body and your mind for labor. As you build this habit, consider the following tips:

• Choose a lubricant that works for you. If you use lubricant, natural oils like coconut oil often work well. If you have allergies or sensitivities, avoid products that tend to irritate your skin. “The lube you normally use during sex may be a good option,” says Dr. Barker.

• Create a relaxing environment. Anything that calms your nervous system can help your pelvic floor muscles relax. You might dim the lights, play calming music, or do a few minutes of diaphragmatic breathing before you begin. 

• Be patient with yourself. It’s very normal for the first few sessions to feel awkward, emotional, or a bit uncomfortable. Over time, many people notice the sensations become more familiar and more comfortable.

• Pair it with pelvic floor awareness. Practice consciously relaxing your pelvic floor muscles during massage — a skill that’s also valuable during labor. Dr. Barker recommends diaphragmatic breathing that gently expands your rib cage; as the diaphragm lengthens, the pelvic floor naturally follows and lengthens, too. If it helps, you can briefly tighten your pelvic floor in a Kegel, then slowly relax and imagine an elevator lowering down and out.

What to expect: Does perineal massage hurt?

Perineal massage involves stretching tissues that may feel tight or sensitive, so some discomfort — especially at first — is common. Overall, though, it should feel gentle and manageable, not sharply painful.

You may notice certain areas feel more intense than others. Think of that as information rather than a sign of damage. You can always adjust by using less pressure, changing position, or focusing on a different area that feels easier that day.

“You’re in charge of the experience, and more pain doesn’t mean you’re getting better results,” says Dr. Barker. “Aim for a stretch that feels productive but still safe and tolerable.”

When to talk with your healthcare provider

Perineal discomfort during pregnancy is common, and perineal massage is generally considered safe to start from about 35 weeks for many pregnant people. Still, everyone’s pregnancy is unique, so it’s important to loop in your healthcare provider with any questions.

Talk with your healthcare provider before starting perineal massage if you have:

• Any pregnancy complications or high-risk factors

• A history of preterm labor or current concerns about preterm labor

• Placenta previa or other placental complications

• Active infections or unexplained vaginal bleeding

• Concerns about your pelvic floor health or previous traumatic birth experiences

Stop perineal massage and contact your provider if you notice:

• Sharp or worsening pain during or after massage

• Bleeding or unusual discharge

• Signs of infection (such as fever, unusual odor, or increasing pain)

• Contractions or other signs of possible preterm labor

These signs don’t automatically mean something is seriously wrong, but they’re good reasons to get personalized guidance.

PT tip: Connect perineal massage with pelvic floor relaxation

Perineal massage tends to work best when it’s paired with intentional pelvic floor relaxation.

Many people — especially when they feel pressure, stretching, or strong emotions — automatically tense their pelvic floor. During birth, that tension can work against the relaxation and opening needed for your baby to descend.

“Your massage sessions are practice time for the ‘release and lengthen’ cues that are helpful during labor,” says Dr. Barker. “Whenever you feel yourself tightening in response to pressure, see if you can soften and breathe into that area instead.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012). Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings, 87(2), 187–193. doi:10.1016/j.mayocp.2011.09.004

2. Milka, W., Paradowska, W., Kołomańska-Bogucka, D., & Mazur-Biały, A. I. (2023). Antenatal perineal massage – risk of perineal injuries, pain, urinary incontinence and dyspareunia: A systematic review. Journal of Gynecology Obstetrics and Human Reproduction, 52, 102627. doi:10.1016/j.jogoh.2023.102627

3. Rodrigues, S., Silva, P., Rocha, F., Monterroso, L., Neves Silva, J., Quintal de Sousa, N., & Escuriet, R. (2023). Perineal massage and warm compresses – randomised controlled trial for reduce perineal trauma during labor. Midwifery, 124, 103763. doi:10.1016/j.midw.2023.103763