For most of a woman’s life the perineum tends to be just another part of the pelvic floor — a fleshy, muscular space between the anus and vaginal opening that’s taken for granted at spin class. But the perineum is a crucial anatomical player in childbirth. So much so that a perineal massage, applied regularly in the later stages of pregnancy can lead to an easier and less painful delivery. And the good news for expectant fathers? They’re in the unique position of being able to offer perineal massage and connect with their partner in the process.
How Does a Perineal Massage Help?
According to prenatal massage therapist and doula Sara Lyon, author of The Birth Deck, the term massage is something of a misnomer. Giving perineal massage isn’t like kneading the back muscles into submission. It’s far more subtle.
“The vagina and the birth canal is not an inert hole,” Lyon says. “It’s not like a piece of meat. It’s a sphincter. It can open. The circular muscle fibers can relax.”
Lyon says that perineal massage is both physical and psychological. The goal is as much to train the muscles as it is to help both partners understand just how much a woman’s body can open to accommodate the passage of a baby into the world.
“So instead of physically massaging you are using your hands as a tool to put pressure on the perineum and allow mom to mentally relax her muscle,” Lyon explains. “Discomfort and pressure can be met with surrender and breath that will allow you to release the muscle. You’re helping to train the mind and body for when the infant’s head exits right at the vagina at the bottom of the birth canal.”
What is the Perineum and Where is it Located?
To understand how to locate the perineum, it needs to put in the full context of a woman’s external reproductive anatomy. Here’s a refresher from top to the bottom.
At the top of a woman’s pelvis is the mons pubis. It’s the fatty covering of the pubic bone, easily recognized in women who don’t shave or wax as where the pubic hair starts. The labias are the outer lips that descend from the pubis, parallel to the inner thighs. The labia minora are the inner lips — small and interior on some women and protruding outside the labia majora on others.
The clitoris is located just under where the labial folds begin and the vaginal opening is interior to the labia minora. This is where the baby head will exit. Following the labia lips towards the posterior, they meet again and terminate where the perineum begins. The perineum is the space between the labia and the anus and has a layered structure of skin, fat, and muscle.
“That muscle is deeply connected to the core and pelvic floor muscles,” says Lyon. “And it’s important to know how to relax that muscle. It tends to be hyper-tonic, or extra tight, for modern women who engage in pilates or other forms of exercise.”
The goal of perineal massage is to help moms-to-be learn to relax the muscle so a baby can pass more easily.
How to Do a Perineal Massage
Because a perineal massage requires both focus and relaxation, couples will first want to make the environment as comfortable and soothing as possible. Candles and healing music aren’t necessary, but they can help. The idea is to help signal that it’s time for some intentional practice and bodywork and couples remove themselves from the distracting daily hustle. It should be taken as a given that cellphones should be banished for the duration of the massage.
Couples should have vaginal lubricant or coconut oil on hand to make perineal manipulation easier and couples might want to place a towel under the pregnant woman’s bottom to avoid mess. Moms-to-be should position themselves on their backs, uncovered at least from the waist down with their legs spread in a butterfly position. They need to be in a relaxed and comfortable position with the understanding that the goal is to relax from head to toe.
“The throat, the diaphragm, and the pelvic floor are like three locks that interact with each other,” Lyon says. “They all have to be relaxed for any one of them to be relaxed.”
After the partner positions themselves, the couple should start matching breath. That means that women find a relaxed, intentional breathing pattern and their partners match that breath. This is important because breath will be an important indicator during the massage.
The technique is as follows:
- Upon explicit consent, the partner inserts their index and middle finger into the recipient’s vagina.
- The partner then slowly presses down and back, toward the bottom, until the recipient indicates the pressure has become uncomfortable but not painful.
- The recipient then breaths and releases into the stretch, keeping her mouth and throat relaxed. A moan is okay. Once the muscle has relaxed, the recipient can indicate she’s ready for more pressure and the process is repeated.
“As an added part of the process she can start with a kegel and a release before adding pressure,” Lyon says. “That way she can understand that there is control. She can tighten and stretch. It can help to work through postpartum fears too. This muscle bounces back.”
Most importantly, partners need to be incredibly in tune with the recipient. Particularly look for catches in breath as an indicator that the stretch needs to slow down. The massage process should not be vigorous or intense. It’s simply about slow steady pressure and communication.
Couples can start practicing perineal massages as early as 36 weeks into pregnancy. “You’ll want to do it between 20 and 30 minutes each session,” says Lyon. “Ideally you do it three to four times a week.”
Finally, what happens at the end of the session is completely up to the couple. “Sex is great for birth,” Lyon notes. So if it happens, great. But partners should not expect anything (hear that?). Because in the end, perineal massage is intended for childbirth easier.