Perineal Massage in Pregnancy

What perineal massage is

Perineal massage is stretching the perineum, the area between your vagina and your anus, with your thumbs or fingers in the last weeks of pregnancy. The aim is to make it less likely you will need stitches after a vaginal birth. The NHS says: "Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth." Most methods studied, it adds, "involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum."

It is optional, and something you or a partner do at home. It is separate from perineal massage during labour, which NICE says midwives can consider in the second stage if you prefer it to a warm compress; see the pushing stage.

Does perineal massage work?

Modestly, and mainly by reducing episiotomies. The main evidence is a Cochrane review by Beckmann and Stock, last updated in 2013, which pooled four randomised trials of 2,497 women who massaged with their fingers for at least the last four weeks of pregnancy.

• Fewer stitches: massage reduced perineal trauma needing stitches by 9% (risk ratio 0.91). "For every 15 women who practise digital perineal massage antenatally, one fewer will receive perineal suturing following the birth."
• Fewer episiotomies: women who massaged were 16% less likely to have an episiotomy (risk ratio 0.84). The authors concluded that the drop in stitching "is almost entirely due to the fact that she is less likely to have an episiotomy."
• First births only: both findings were significant only for women who had not given birth vaginally before.
• No change in tears: there was no difference in first or second-degree tears, or in third and fourth-degree tears.
• Less pain later, if you have given birth before: in one trial of 376 women, those who had previously had a vaginal birth were less likely to report perineal pain three months after the birth (risk ratio 0.45).

The review found no differences in forceps or ventouse births, sexual satisfaction, or leaking of urine, faeces or wind. A 2026 umbrella review of eight systematic reviews, in the International Urogynecology Journal, found antenatal massage showed "more modest episiotomy reductions" than massage in labour and "inconsistent effects on severe tears", with evidence certainty from very low to moderate.

The RCOG lists what makes third and fourth-degree tears more likely: a first vaginal birth, a baby over 4 kg, a long second stage, shoulder dystocia, and a forceps or ventouse birth. Our page on perineal tears and stitches explains the grades.

When to start perineal massage

From 34 or 35 weeks, depending on whose guidance you read. The trials in the Cochrane review mostly began at 34 weeks.

How often: why the advice differs

UK guidance says daily; Australian guidance says once or twice a week and that "doing it more often than this is usually not recommended." The trials asked for daily or three to four sessions a week, and the Cochrane authors split the results by how often women actually massaged.

Women who massaged up to an average of 1.5 times a week had a 16% reduction in trauma needing stitches. At 1.5 to 3.4 times a week it was 8%, and above 3.5 times a week the reduction was not statistically significant. The test for differences between these groups found none, so the pattern may be chance. The most frequent massagers had a longer second stage, by about 11 minutes on average, though among women who had given birth before they were the least likely to report perineal pain afterwards.

In practice, a couple of times a week appears to capture the benefit for a first birth; the review found no extra reduction in stitches from massaging more often.

How to do perineal massage, step by step

1. Prepare. Cut long nails, wash your hands and empty your bladder. A warm bath or shower first softens the skin and helps you relax.
2. Get comfortable. The RCOG suggests sitting up in bed, propped on pillows with your knees bent; the HSE suggests squatting against a wall or sitting on the toilet. A mirror can help at first.
3. Use a lubricant. The RCOG names vitamin E, almond or olive oil. The HSE adds water-based lubricants and other natural oils, and says not to use scented or synthetic products. Avoid nut-based oils if you have a nut allergy.
4. Stretch. Put your thumbs about 3 to 5 cm inside your vagina. Press down towards your anus and out to the sides until you feel a stretching sensation. The RCOG says hold for about 1 minute and breathe deeply.
5. Massage. Gently massage the lower half of your vagina in a U-shaped movement for 2 to 3 minutes. The RCOG suggests repeating this 2 to 3 times.
6. Stop at 5 minutes. Pregnancy, Birth and Baby says a session should last no longer than that.

Expect it to sting or burn at first. In a follow-up of the largest trial, most women said the burning had eased or gone by the second or third week; 79% said they would massage again and 87% would recommend it.

Who should not do perineal massage

Pregnancy, Birth and Baby advises against it if you:

• are less than 34 weeks pregnant
• have a low-lying placenta (see placenta praevia)
• have a short cervix
• are bleeding from the vagina
• have an infection such as thrush or genital herpes
• have severe blood pressure problems in pregnancy.

The HSE adds vaginal warts. Pregnancy, Birth and Baby also says to speak to your midwife or doctor first if you have had perineal surgery or your waters have broken. If you tore in a previous birth, tell your midwife; the HSE says "in most cases, you can still do perineal massage."

Other ways to reduce tearing

The RCOG says kneeling, being on all fours or lying on your side may reduce the severity of tearing, as can a warm compress on the perineum, a "hands-on" birth where your midwife supports the perineum, and a slow, controlled birth. NICE recommends offering a warm compress once the baby's head is stretching the perineum, and says not to carry out a routine episiotomy during a spontaneous vaginal birth. See positions for labour and pushing and episiotomy, and add your preferences to your birth plan.

Frequently asked questions

When should you start perineal massage?

From 34 or 35 weeks of pregnancy. Ireland's HSE says from 34 weeks, the RCOG says from 35 weeks, and Australia's Pregnancy, Birth and Baby says around 34 or 35 weeks and not before 34. The RCOG says to carry on until your baby is born.

Can my partner do perineal massage?

Yes, if you are both comfortable. Pregnancy, Birth and Baby says a partner should have clean hands, use their thumbs or one or two index fingers, and be guided by you. In the Cochrane trials most women felt positive about their partner taking part.

What oil is best for perineal massage?

The guidance does not single out one oil. The Cochrane trials used sweet almond oil; the RCOG suggests vitamin E, almond or olive oil; the HSE also lists water-based lubricants and says to avoid scented or synthetic products. Choose a non-nut option if you have a nut allergy.

Do you need a perineal massage wand?

No. The Cochrane review only covered massage with fingers, and the NHS, RCOG, HSE and Pregnancy, Birth and Baby all describe using your thumbs or fingers. None of them recommends a device, and the review contains no evidence on wands.