(646) 355-8777

Herman & Wallace Blog

Perineal Massage for Childbirth

Perineal massage involves pelvic floor muscle stretching by application of an external pressure to muscle and connective tissue in the perineal region. It is performed 4 to 6 weeks before childbirth to help the soft tissue in that region to withstand stretching during labor. This helps to prevent perineum during birth by decreasing the need for an episiotomy or an instrument-assisted delivery. Lengthening of skeletal muscles is known to modify the viscoelastic properties of the muscle-tendon unit, which decreases the tension peak of the musculature and therefore, chances of injury.

Pelvic floor muscle stretching is performed via widening of the hiatus in the axial plane. Perineal massage is a simple technique has been found to be associated with a decrease in the incidence of perineal tears requiring suture or an episiotomy. It has also been reported to reduce postpartum pain.

Instrument-assisted stretching is performed with the help of an inflatable silicon balloon that can be pumped to gradually stretch the vagina and perineum. However, the evidence to support its benefit is lacking. In fact, there is some concern that pelvic floor muscle stretching may cause a decrease in muscle strength. Some have argued that such exercise neither improve or worsen pelvic function (Labrecque M, et al., Medi-dan, et al.). While a meta-analysis by Aquino, et al. concluded that perineal massage during labor significantly lowered risk of severe perineal trauma, such as third and fourth degree lacerations (Aquino, et al.).

A recent major study done by deFreitas, et al., perineal massage and instrument-assisted stretching were found to improve perineal muscle extensibility when performed in multiple sessions on primiparous women beginning at 34th week of gestation, which is very helpful in preventing child trauma in labor; however, there was no increase in muscle strength.

The technique of performing the manual perineal massage (as exemplified in the aforementioned study) may involve two sessions per week for a month by an OBGYN-focused physiotherapist. The patients are rested in dorsal decubitus position with the inferior limbs semi-flexed and the lower limbs and feet supported on the examination table. Coconut oil can be used for the perineal massage - which starts off with circular movements in the external area of the vulva, around the vagina and in the central tendon of the perineum, followed by the index and middle fingers inserted approximately 4 cm in the vaginal introitus for an internal massage of the lateral walls of the vagina ending toward the anus, repeated four times on each side, with the whole process lasting approximately 10 minutes.

Instrument-assisted procedure may include inserting the instrument (Epi-No) covered with a condom and lubricated with a water-based gel, inflated at the vaginal introitus so that 2 cm of the balloon is visible, making sure the patient can tolerate the stretching, and are advised to keep the pelvic floor relaxed as the instrument is slowly expelled during expiration. Physiotherapist supervision is necessary in order to maintain the correct positioning of the balloon as it lengthens the muscles. He/she will also ensure proper expulsion of the equipment during expiration.

Overall, perineal massage techniques (with or without instrumentation) are beneficial in terms of preventing trauma during labor. There are many studies that support the efficacy of these techniques in doing so (Leon-Larios, et al.). But it is also important to appreciate the limitations and use it judiciously.


Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Labrecque M, et al. Am J Obstet Gynecol. 2000.
Perineal massage during pregnancy: a prospective controlled trial. Mei-dan E, et al. Isr Med Assoc J. 2008.
Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. Aquino CI, et al. J Matern Fetal Neonatal Med. 2018.
Effects of perineal preparation techniques on tissue extensibility and muscle strength: a pilot study. de Freitas SS, et al. Int Urogynecol J. 2018.
Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial. Leon-Larios F, et al. Midwifery. 2017.

Fiber – The Unexpected Ally in Breast Cancer Recov...
Pelvic, Sexual, and Bone Health at Menopause

Upcoming Continuing Education Courses

Jan 11, 2019 - Jan 13, 2019
Location: Spooner Physical Therapy

Jan 11, 2019 - Jan 13, 2019
Location: Highline Physical Therapy

Jan 11, 2019 - Jan 13, 2019
Location: Tri-City Medical Center

Jan 18, 2019 - Jan 20, 2019
Location: Providence Healthcare

Feb 2, 2019 - Feb 3, 2019
Location: UCLA Rehabilitation Services

Feb 8, 2019 - Feb 10, 2019
Location: Florida Hospital - Wesley Chapel

Feb 16, 2019 - Feb 17, 2019
Location: Harrison Medical Center-Silverdale Rehabilitation

Feb 22, 2019 - Feb 24, 2019
Location: Inova Physical Therapy Center

Feb 22, 2019 - Feb 24, 2019
Location: Rocky Mountain University of Health Professions

Feb 23, 2019 - Feb 24, 2019
Location: NorthBay HealthCare

Mar 1, 2019 - Mar 3, 2019
Location: Virginia Hospital Center

Mar 1, 2019 - Mar 3, 2019
Location: University of North Texas Health Science Center

Mar 1, 2019 - Mar 3, 2019
Location: Dignity Health Care of Stockton, CA

Mar 8, 2019 - Mar 10, 2019
Location: The Woman's Hospital of Texas

Mar 8, 2019 - Mar 10, 2019
Location: Bon Secours St. Francis Health System

Mar 8, 2019 - Mar 10, 2019
Location: Franklin Pierce University

Mar 15, 2019 - Mar 17, 2019
Location: Legacy Health System

Mar 15, 2019 - Mar 17, 2019
Location: Kinetic Kids Inc

Mar 15, 2019 - Mar 17, 2019
Location: Indiana University Health

Mar 22, 2019 - Mar 24, 2019
Location: Mount Saint Mary’s University

Mar 22, 2019 - Mar 24, 2019
Location: Tri-City Medical Center

Mar 23, 2019 - Mar 24, 2019
Location: Spooner Physical Therapy

Mar 23, 2019 - Mar 24, 2019
Location: Alta Bates Summit Medical Center

Mar 29, 2019 - Mar 31, 2019
Location: Marathon Physical Therapy

Mar 29, 2019 - Mar 31, 2019
Location: St. Joseph Mercy Ann Arbor

Mar 30, 2019 - Mar 31, 2019
Location: Core 3 Physical Therapy

Mar 30, 2019 - Mar 31, 2019
Location: Atlanta PT

Apr 5, 2019 - Apr 7, 2019
Location: Athletico Physical Therapy

Apr 5, 2019 - Apr 7, 2019
Location: Vanderbilt University Medical Center

Apr 6, 2019 - Apr 7, 2019
Location: Aurora Medical Center