You want me to massage what?!? “Vagina massage” can be extremely beneficial to a woman who needs it. The perineum is the area between the vaginal opening and your butt hole. You may hear about massaging the perineum during third trimester to help soften the tissues and prepare for a vaginal birth. This also may help women who have tight, tense pelvic floor muscles causing pain with sex, incomplete bladder emptying, constipation, vaginal pain/itching/burning, or pain with sitting.
I first learned about perineal massage during my continuing education as it pertains to using it during pregnancy for prevention of tearing during childbirth. It was also discussed in its uses postpartum for healing and working on scar tissue. There is some research on this topic. The evidence is mostly in regards to helping decrease tearing during first time pregnancies. However, the individual feedback I’ve received from clients and the case studies I’ve read lead me to think this is a mostly beneficial exercise to perform during pregnancy and postpartum if it feels right for you. Performing some perineal massage if you’re open to it might be worth considering, as long as you don’t have any precautions surrounding internal work (do your own research and discuss this with any providers you’re working with before beginning).
How does this help?
Your pelvic floor muscles sit at the base of your pelvis and help support your pelvic organs, hold in pee and poop until you are ready to empty, and have a role in sexual activity and childbirth. However, these muscles are like any other muscles in your body. They can get short and tight and go into spasm. This can cause vaginal penetration to be difficult and sometimes impossible. Pain can also occur with deeper penetration, with orgasm, or even after intercourse is over. These muscles need to be lengthened and relaxed to their normal resting state.
A Pelvic Floor physical therapist can do manual therapy to downtrain and relax those muscles. “Vagina massage” or manual therapy uses a finger pad to apply pressure to a tense or overactive muscle to improve blood flow and relaxation. It can especially be helpful for postpartum women, those who experience pain with sex, or those who have cesarean section scars and perineal tears.
For expecting mothers
For pregnant mamas, there are no negative effects and perineal massage during childbirth has been shown to decrease severity of vaginal tearing. Start around 34-35 weeks and learn how to properly bear down during childbirth to ensure pelvic floor muscle relaxation. Avoiding breath holding! Perineal massage can also be performed after a vaginal tear or episiotomy. Once the scar is healed, gently massage the area to soften the scar tissue. Postpartum, make sure to be very gentle with your pressure as these tissues are still healing.
How do I do it?
There are several different ways to perform manual therapy on these pelvic floor muscles: with a device called a crystal wand, a therapist or partner can perform, or vaginal dilators (they look like tampons of different sizes) can also help retrain the vaginal wall muscles to relax.
I’ll use a clock face as an example of how to describe a perineal massage as it pertains to the vaginal opening:
12:00 being towards the urethra and clitoris
6:00 being towards the perineum and anus
Usually instructions are something like below:
Insert a clean finger in the vaginal opening towards the 6:00 position.
Press down and hold for 30-60 seconds (your goal is to feel a stretch, maybe a little tingling, but not pain greater than 3/10).
Move your finger gently towards 3:00 then back to 6:00 then over to 9:00 making a “U” and holding within that region 30-60 seconds in a few different spots.
You could also enter a second finger or more and work to spread the vaginal opening wider from 3:00-6:00 and 6:00-9:00 or 3:00-9:00.
Perform for a few minutes (~5min), even 1 minute is a great starting place.
Perform daily or every other day.
*Helpful tip is that this may feel like a burning/tingling sensation similar to if you hook your fingers around your lips and pull them apart.
*There was absolutely no way I was able to demonstrate this in a flattering way, haha.
My own experience with perineal massage during pregnancy
I can’t remember exactly when I started perineal massage during my pregnancy, but somewhere around 35-36 weeks. My own goal was to mentally feel prepared to expand the tissue in that region when the baby’s head needed to make its way through. I performed it in the shower a few times but found it a bit awkward to reach around and also to remember to do it in that setting. I tried it lying down in bed in a propped position reclined back with pillows and side lying which to me felt more comfortable. I tried it with my fingers, my thumbs and with a dilator from Intimate Rose.
I also asked my husband for help once, but turns out I did not enjoy that version and opted to continue solo. I probably only performed the perineal massage 2x per week. Ultimately there was a time near 38-39 weeks that I didn’t want to do it anymore but felt I needed to push the stretch further to almost the size of a fist, so that I could feel more empowered/prepared mentally. I had read about this concept in the book, The Fourth Trimester by Kimberly Ann Johnson. I did that once and then felt I was ready for whatever came my way.
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Jen Torborg, PT, DPT, CMTPT, is a pelvic floor physical therapist and author of three Amazon bestselling books: Your Best Pregnancy Ever, Your Best Body after Baby, and Your Pelvic Health. Jen treats clients in Ashland and Bayfield, Wisconsin through Orthopedic & Spine Therapy.
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