Perineal massage can especially be helpful for postpartum women who experience pain with sex, or to preform perineal scar mobilization on those who have had perineal tears during childbirth. It can help improve blood flow to the area and encourage muscle relaxation. But what is it exactly, and how do you do it?
Why do perineal scar massage?
The perineum is the area between the vagina and anus. Benefits of perineal massage include:
- Pain with sex
- Incomplete bladder emptying
- Constipation
- Vaginal pain/itching/burning
- Pain with sitting
Perineal massage can also be helpful during pregnancy to reduce the risk of tearing during delivery.
How to perform perineal scar massage
There are several ways to perform manual therapy on the pelvic floor muscles. This will help retrain the vaginal wall muscles to relax. Make sure to wash your hands with soap and water before starting. Below is a step by step guide on how to do it.
Let’s 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
- Using your index finger, 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, a little tingling, but not pain greater than 3/10.
- Move your finger towards 3:00 then back to 6:00 then over to 9:00. You want to make a “U” and hold 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.
Returning to touch
When returning to touch of your vulva/vagina postpartum, choose ways that feel comfortable and appropriate for you.
Perineal scar healing
The first week or so, it may be helpful to imagine your “thighs glued together” when walking. Minimize stairs as much as possible as well. Both of these can help the tissue heal.
You can also begin to lightly touch your vulva, perineum, and perineal scar site to decrease any hypersensitivity during the healing process. Use very, very gentle touch during this part and only external. You can also do this over underwear or in the shower.
Around 4-5 weeks postpartum, you may begin to touch the scar with slightly more pressure. Still stay mostly external.
Around 5-6 weeks you may decide you feel ready to start using internal touch. You can do this at first with your finger while in the shower or lying down. One you feel ready, you can introduce a dilator if desired and perform the massage again.
Once you are 6-7 weeks you will likely have your appointment with your provider. They will give you more of an idea as to how your tissue is healing.
Based off of that appointment, you may began more scar tissue work on your perineal scar. As the sensitivity, pain, and numbness begin to decrease at the scar site and touch to the vulva, perineum and vagina feel better, you may feel ready to resume sex.
