The Uber-Perineum

By: Michael Krychman MD

What is the Perineum?

The perineum is the area of tissue that is between the vaginal opening and the anus. It has a critical role in support of the genital pelvic organs, the bowel, and bladder. This area can tear or may be intentionally cut during a medical episiotomy to help with childbirth.

What is Perineal Massage?

Gentle manual stretching and softening the perineal area with one or two fingers can help the baby’s head smoothly glide out of the birth canal during a vaginal delivery. Either you or your partner can learn how to perform perineal massage before your delivery date. Some health care professionals may also advocate perineal massage during the labor and delivery process, when a woman is pushing, to help minimize tears and cuts.

Benefits of Perineal Massage?

It has been estimated that up to 80% of all women who deliver vaginally may experience some vaginal tearing as part of the childbirth process. Most of these tears will require suturing with stitches. If you damage your perineal tissues during childbirth, you may be at risk for future medical and gynecological problems such as pelvic floor disorders and involuntary loss of fecal, flatus or urine. Sexual discomfort and genital prolapse may also occur.

In the recent American College of Obstetrician/Gynecologist Practice Bulletin, it reiterates that digital perineal massage from 34 weeks of gestation onward was associated with a modest reduction of perineal trauma requiring sutured repair. It also decreased episiotomy in women without a previous vaginal birth.

Massage prepares the perineal tissues to stretch. It may increase blood flow and result in less childbirth pain. It may lower the risk of childbirth tears and the need for stitches should a vaginal laceration or tear occur. Also, your tears will be less severe if they should occur. Massage has also been known to help those who have had previous scars in the perineum. Focusing on massage of the perineum may also help you prepare for the childbirth experience: you will learn how to focus on your pelvic muscles and monitor them for relaxation.

When to start Perineal Massage?

You can start at 34-36 weeks of gestation with some light perineal massage. You should start slow at one to two times a week and work your way up to every other day. A massage session need not be very long, it can be 5 to 7 minutes in duration, 12 times a week.

Perineal Massage during delivery?

Recent review of published literature showed that women who received massage during the second stage of labor (when they are pushing) had a lowered risk of both third­ and fourth­ degree lacerations.

How to do Perineal Massage

Use a lubricant to eliminate friction. Überlube with its slickness and inert qualities make it an excellent choice for perineal massage. Find a comfortable, private place where you will not be disturbed and wash your hands. Lock your door to prevent interruptions. Fingernails should be trimmed to avoid accidental pokes or scratches. You can also massage when standing in the shower or during a leisure bath. Some women prefer sitting, squatting or having one leg elevated on the toilet when doing massage in the restroom.

Apply lubricant to your thumbs or fingers and place them about 1 1⁄2 inches within the vaginal canal. You may need to use a handheld mirror for your first few times. Then gently press your thumbs/ index fingers or middle fingers, against the back wall of the vagina towards your anus. Be gentle! Keep your fingers in a stretched position for a few minutes while relaxing your muscles. You should feel pressure NOT pain. Move your thumbs outward and inward in a U­shaped configuration. You may experience sensation on both the inside and outside of the vagina. Breathe. Relax. Repeat.

Support is always available

Consider consultation with your health care professional should you experience any significant discomfort or vaginal pain. Your health care professional can and should help you learn how to accurately perform perineal massage and make sure it is safe to perform during your pregnancy.

A final word about partners. It may be cumbersome in the later stages of pregnancy to massage your own perineum, so you can certainly enlist the help of your partner. Perhaps ask him or her to attend your massage sessions, learn by watching, and then gently hand over control to your partner. Your partner can use his or her index finger instead of thumbs during the massage process.

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