What it is
Perineal massage is a way of preparing the tissues of the perineum, between the vagina and the anus, for the stretching that is necessary during childbirth. During birth, the perineal tissues need to stretch a good deal to allow your baby to pass through the birthing canal and if the tissue doesn't stretch enough then it can tear. Slight tearing during birth is quite common, but to prevent substantial tearing midwives or doctors quite often cut into the tissue to give the baby room, a procedure known as an episiotomy.
The aim of perineal massage is to 'train' the perineal tissues to stretch and so help to avoid both tearing and episiotomies, as well as reducing the stinging sensation you experience when your baby crowns. Perineal massage is most effective if practised every day for the last six weeks of pregnancy, so from around week 34, and for between five and ten minutes at a time.
How do you do it?
"Well, sounds great!" You might be thinking, tell me how to do this massage stuff and I'll get cracking. This is where the 'fun' starts, so prepare yourself mentally for sticking your thumbs inside your vagina. Sorry? Yes, I'm afraid that's right, in order to effectively massage your perineal tissues you'll need to be ready to get stuck in there. Advanced students of perineal massage may prefer to get their partners to massage the perineum as an opportunity to share intimacy and involve their other half in childbirth preparations, or even as part of foreplay. But if you'd prefer to ensconce yourself in privacy with a mirror you certainly won't be alone.
You'll need a warm, comfortable environment and privacy, obviously. To massage use a natural massage oil like sweet almond oil, jojoba, coconut butter, wheatgerm or olive oil or a water-based lubricant like KY Jelly. Don't use any petroleum-based products for perineal massage. If you're doing the massage yourself you'll need a mirror, at least for the first few times while you familiarise yourself with the perineal area. A hand-held mirror will be more trouble than it's worth, a large mirror will be easiest.
1. Whoever is giving the massage should trim their thumbnails or finger nails and scrub their hands and nails.
2. Sitting with your legs spread comfortably apart, massage a little oil into the outside of the perineum and on your fingers and thumbs
3. Insert your thumbs about half a thumb length into your vaginal canal, and apply pressure to the perineum, the area between the vagina and anus. If your partner is doing the massage they should use their index fingers. You should stretch the perineum until you feel a slight stinging sensation. When you feel that sensation hold the stretch for about a minute
4. Circle your thumbs to massage the oil into the tissues down to the base of the vagina, gently pulling the tissues forward and back
5. Now apply pressure against the sides of the vagina, moving thumbs in a 'u' shape up from the part of the vagina closest to the anus. Again, you should stretch enough to feel a slight stinging sensation, without inflicting pain on yourself. Gently pull the tissues of the sides of the vagina downwards in imitation of how your baby's head will pull on the tissue during birth. Do this about half-way up the sides of the vagina and don't pull, rub, stretch or put pressure on the urethra at the top
Remember that the massage should be gentle and not abrasive or vigorous. Initially you probably won't be able to stretch the tissues very far before the stinging sensation kicks in, but the point of the massage is that with repetition you'll be able to stretch more and more.
To make sure you do the massage every day it helps if you build it into your daily routine. Some women may find that a bath before-hand helps to relax them ready for the massage, others may find the massage itself relaxing, particularly as they become more adept at it. And if the intimacy of perineal massage gets you and your partner in the mood for love then why the hell not!
And don't forget
To make the most of perineal massage team it with your regular Kegel exercises to increase tone and control of your pelvic floor muscles. If you have good control of your pelvic floor muscles then consciously relax them as you perform the massage.
