Perineal massage or perineal stretching is a technique commonly used in preparation for vaginal childbirth (but can be used in other cases, too).

The perineum is often described as the area of tissue found between the vaginal opening and anus, but we’ll expand on this definition soon.

Perineal massage is a great way to mobilize the perineum and increase flexibility of the surrounding tissues, which can provide a variety of benefits.

Although many people typically think of perineal massage as a technique reserved only for pregnant individuals, it actually does have many other purposes and uses—for anyone! Let’s explore a few examples:

Childbirth Preparation

First, we have childbirth preparation—the most common thing people imagine perineal massage is meant for. Why does perineal massage matter so much for vaginal delivery?

During vaginal delivery, the perineum is exposed to severe pressures and trauma, making it prone to tearing. In some cases of more difficult deliveries, the perineum becomes the primary location for an episiotomy.

An episiotomy is an incision of the perineum designed to allow for a smoother vaginal delivery, but is typically only performed under specific circumstances.

There are many circumstances that may make an episiotomy necessary—for example, if you are at a high risk for severe perineal tearing, your provider may perform an episiotomy.

Perineal tears are less likely to occur if your pelvic floor and perineal tissues are healthy and flexible. But what exactly is the pelvic floor?

Your Pelvic Floor and Your Perineum

The pelvic floor is a group of interconnected muscles, ligaments, and structures within the pelvis. These structures protect and support your pelvic organs, give your body stability and balance, let you use the restroom, experience sexual appreciation, and of course, allow for vaginal childbirth.

The perineum is a part of the pelvic floor, and although it is often described as the piece of skin between the vaginal opening and anus, that’s not all there is to it!

This patch of skin is indeed part of the perineum, but there is actually more structure within the pelvis that not everyone acknowledges.

Deeper within the area is a larger, diamond-shaped fibromuscular structure that you can refer to as the “perineal body.” The perineal body separates the anterior (frontal) and posterior (behind) sections of the pelvic floor.

You may be wondering why you need to know all this. It all comes down to perineal tears! A perineal tear can actually affect more than just the exterior skin tissue of the perineum. In fact, perineal tears can be categorized into four levels of depth:

• 1st-degree tear: A tear affecting the external perineal tissue (skin between the vaginal opening and anus).
• 2nd-degree tear: A deeper tear that affects the muscles of the perineal body and vagina. This is the most common type of tear.
• 3rd-degree tear: A deep tear that affects not only the perineal body, but also other muscles such as the anal sphincter (which controls your ability to make bowel movements). 
• 4th-degree tear: The deepest and rarest form of perineal tear, which can extend all the way to other tissues of the rectum and anal lining. 

1st-degree tearing usually can heal on its own, but 2nd-degree tears and beyond will need stitches. This may seem like a lot of information, it is important to know what could happen in the delivery room.

While it may not be possible to completely avoid all complications of childbirth, you can at least lower your risk of things like perineal tearing by preparing your body beforehand.

Pelvic Floor Health and Function

While improving the flexibility and elasticity of the perineal muscles and other pelvic floor tissues is a great way to prepare for childbirth, non-pregnant individuals can benefit, too.

For example, perineal massage can help address pain and other symptoms caused by tight pelvic floor muscles, such as constipation and other bowel troubles. This is because tight, painful pelvic floor muscles can make bowel movements more difficult, resulting in straining and even hemorrhoids.

Regular stretching and massage can help encourage tissue flexibility and blood flow, which will support healthy bowel movements and bladder health, too.

Improving Sexual Function

Aligning with the previous example, improving pelvic floor health and mobility can also aid in sexual function.

Individuals who experience discomfort or a lack of sensation during sex may find improvement with perineal massage. Stretching and mobilizing the area can help improve flexibility, reduce tightness, and enhance blood flow.

These benefits of perineal massage can improve comfort with sexual activity, and can serve as a form of desensitization and relaxation for individuals with conditions such as vaginismus or anxiety.

Perineal massage may seem simple, but it can empower individuals to take their health into their own hands, at their own pace.

Scar Tissue Mobilization

Perineal massage can be very useful for individuals who are postpartum or who have experienced pelvic surgeries. Scar tissue from injury, surgery, or childbirth can be restrictive, uncomfortable, and in some cases, painful.

This scar tissue can be addressed with perineal massage and mobilization techniques, which improve flexibility, mobility, and comfort.

Start Healing with Hive

As mentioned before, perineal massage aims to improve the health of your perineum and pelvic floor. It isn’t just a massage to the outer perineal skin, but to the inner muscles and tissues, too.

This technique improves flexibility and elasticity of these tissues. Massage can improve blood flow, as well as soften and relax perineal tissues—which allows for proper pelvic floor function.

When it comes to childbirth, many individuals do not properly prepare their pelvic floor or perineum beforehand, and so perineal tears are very common.

In most cases, the perineum and pelvic floor don’t typically experience the same degree of stretching or trauma outside of experiences such as childbirth or injury. If these tissues are suddenly introduced to this level of stretching without any preparation, tearing is very likely.

Additionally, childbirth can be unpredictable. While planning for certain circumstances can be very helpful, there’s no telling what will occur in the delivery room. Childbirth involves many different variables—so it’s best to at least work on what you can control!

That includes preparing for childbirth ahead of time by giving your pelvic floor and perineum a bit of extra love.

As mentioned earlier in this article, perineal massage can be used for purposes other than childbirth, too.

It can be very beneficial for anyone’s pelvic floor health by decreasing muscle tension and improving tissue flexibility. For those who experienced previous injuries, sexual trauma, or vaginal deliveries that resulted in scar tissue or pelvic floor tightness, perineal massage can be a very beneficial technique to learn.

Additionally, anyone experiencing pelvic floor dysfunction—constipation, painful sex, painful urination, and more—can benefit from perineal massage. In other words, perineal massage offers a lot of advantages and little to no downsides for most individuals!

Keep in mind that in some rare instances, pregnant individuals may be contraindicated to perineal massage. If you have a low-lying placenta, vaginal infection, or vaginal bleeding in your third trimester, be sure to consult with your primary provider about your interest in perineal massage.

Regardless of your health goals or needs, working with a pelvic floor therapist is a great way to ensure safety, proper technique, and the best results from perineal massage. We’ll discuss the advantages of working with a pelvic floor therapist next!

A pelvic floor therapist can support your pregnancy journey or overall pelvic floor health by teaching you proper techniques for perineal massage.

While massaging your own body may seem like a simple task, working with a pelvic floor physical therapist can have tremendous benefits. A professional can ensure you utilize proper technique to maximize the effectiveness and outcomes of the massage.

They will be able to incorporate other aspects of pelvic floor care into your routine that will further enhance your experience with perineal massage. You’ll get the best results when combining perineal massage with other pelvic floor treatments!

By working with a provider, you will gain the knowledge and advice necessary to not only benefit as much as possible from the technique, but to also perform the massage both independently and safely.

Additionally, a professional will be able to help tailor your perineal massage technique to your own specific needs, condition, or concerns.

Below, we’ve outlined some ways that a pelvic floor therapist can support your journey to better perineal and pelvic floor health:

Education and Guidance

Although a lot of information has been provided here, your Hive physical therapist will be able to further educate you on bodily anatomy or advantages of perineal massage.

They can answer any questions you have about those topics, as well as any other topics like pelvic floor dysfunction or childbirth preparation.

Pelvic floor therapists often have diagrams or physical models that can help you better understand your anatomy and the perineal massage process.

They’ll also help you set goals for your perineal massage and provide in-depth instruction as needed. This can involve aspects like body positioning, tips for maintaining good hygiene during the process, and suggestions for tools such as lubricants or mirrors.

They can guide you through the actual massage process, ensuring you use the correct directional movements and pressure. Your physical therapist can even help determine an appropriate massage frequency or routine for your individual needs.

Supplemental Treatments or Techniques

While perineal massage is very useful, the pelvic floor and perineum can benefit even more from other treatments used alongside it.

Your pelvic floor therapist can help teach you relaxation techniques such as diaphragmatic breathing, which helps relax both the mind and the pelvic floor muscles. These mindfulness techniques can ease anxiety and significantly improve your experience with perineal massage.

Additionally, your pelvic floor therapist will be able to examine your current pelvic floor health and muscle tightness, and suggest other treatments as needed.

Although every person’s health and situation varies, many individuals are in need of pelvic floor training and can further enhance their pelvic floor heath with additional treatment.

This is especially so for individuals who currently experience symptoms of pelvic floor dysfunction.

Long-Term Support and More

Lastly, pelvic floor therapists can play an important role in providing motivation and encouragement for their patients.

For some, perineal massage may seem like an easy task that they can handle on their own—but for others, massaging this area of their body may feel awkward, confusing, or even scary. Your Hive physical therapist is here to dispel any shame or uncertainty you may have!

Not only can they help improve your confidence through guidance and instruction, but learning from a professional about bodily anatomy, childbirth, sexual health, or the massage process itself can help dispel fears from uncertainty or a lack of understanding.

At Hive Therapy and Wellness, we want to encourage you to take hold of your health and feel reassured in your goals. If you have questions, feel free to ask away! We are here to support you.

Additionally, your Hive pelvic floor therapist can supplement your perineal massage journey by measuring your progress, providing guidance if you come across any problems, and even offering recommendations for supportive tools.

This can include physical tools or devices to assist in the stretching or massage process, as well as other helpful advice for getting started.

At Hive Therapy and Wellness, we believe in holistic, comprehensive treatment.

While our providers can guide you through perineal massage techniques, they may also recommend other beneficial treatments to further enhance your pelvic floor health. These treatments may include any of the following:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback