Chloe Lorback, Women’s Health Physio, loves helping women live their best life, with the right movement and mindset. She knows too well the barriers to achieving optimal pelvic floor strength and sexual wellness and is an advocate for The Aspen.

Perineal massage. Heard of it? Tried it? Maybe you skipped straight over that section in the info sheets from your midwife or OB because you were thinking “yeah but nah” (like I did).

However, a recent systematic review — which looks at all the research in this area and combines the findings — has sparked renewed interest in this age-old birth preparation technique.

The latest research has revealed that perineal massage can be very effective when it comes to reducing tearing during delivery (Abdelhakim et. al., 2020). In this review, which included over 3,400 women, they found that antenatal perineal massage is associated with a lower risk of episiotomies and perineal tears, particularly the 3rd and 4th degree tears. These are compelling findings.

But despite the evidence, we know that many pregnant women don’t get around to doing perineal massage. They tell us that it feels a bit weird, they feel awkward trying to reach with their fingers or they’re not sure if they are doing it right.

Recently, pelvic health physios have been more involved in helping women understand the benefits of perineal massage, along with midwives and obstetricians, as we love it when research supports the anecdotal evidence, and we all want great outcomes for our clients.

And in the last few years, there has been renewed focus on reducing the risk of birth trauma, including perineal tearing and pelvic floor dysfunction, as awareness and advocacy increases. This has also brought these “old” techniques to light.

How do you do it?

The perineum is the area between your vagina and your anus. Research has shown that gently massaging this area later in pregnancy can improve elasticity of the skin and muscles, hopefully reducing the risk of tearing during delivery.

It’s common to have some fear about the stretching and possible tearing that can happen during delivery. During childbirth education classes, this is one of the most common questions women ask about.

From about 35 weeks of pregnancy, you can start preparing your body for labour using perineal massage.

You can use your fingers or thumb, or a personal massage device such as THE ASPEN, which can make it easier for you to reach, and less tiring to do.

1. Gently insert thumbs or 1-2 fingers, or the ASPEN massage device, 3-5 cm into the vagina, and firmly sweep in a downward and side to side motion for three to five minutes. Research shows it is best to practice three times a week. You can use a water based lubricant or natural oil for lubrication. (Avoid nut-based oils if known allergies. Do not use baby oil, mineral oil or petroleum jelly).

2. You may feel a burning sensation which will diminish over time.

3. Most women consider their partner’s involvement as positive.

The benefit of using THE ASPEN during pregnancy for your perineal massage is that you can use it postnatally to gradually start desensitising any perineal scar tissue, as well as providing feedback for your pelvic floor muscle training. When you feel ready, it can also be used to gently start exploring your vulva, vaginal and clitoral sensitivity, focusing on your sexual wellbeing. You can start to rebuild your confidence solo or with your partner, and have a bit of fun with your pelvic floor exercises too.