How To: Perineal Scar Tissue Massage

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perineal massage

Perineal scar tissue forms in the perineum, the area between the anus and the vagina. It can result from various factors, including episiotomy during childbirth, tearing, surgical procedures, or injuries in the perineal region.

Perineal scar tissue massage offers a non-invasive and effective way to address these issues and promote healing. Massage can help postpartum women with painful sex or those who had 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 Perineal Scar Massage?

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 Tissue Massage

There are several ways to perform manual therapy on pelvic floor muscles. This will help retrain the vaginal wall muscles to relax.

Before You Begin:

  1. Make sure to wash your hands with soap and water
  2. Gather a mild, hypoallergenic oil or water-based lube as needed
  3. Get to a comfortable space where you can relax without interruption
  4. Use a mirror if you choose, for optimal visibility

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

Step 1: Using your index finger, insert a clean finger in the vaginal opening towards the 6:00 position.

Step 2: 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.

perineal-scar-tissue-massage

Step 3: 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.

perineal-scar-tissue-massage  perineal-scar-tissue-massage

Step 4: To widen the vaginal opening, use two fingers from different angles. These angles can be 3:00-6:00 and 6:00-9:00 or 3:00-9:00.

perineal-scar-tissue-massage

Step 5: Perform for a few minutes (~5min), even 1 minute is a great starting place.

Perform daily or every other day.

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 gently touch your vulva, perineum, and perineal scar site to reduce sensitivity while healing. Use an extremely 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 that appointment, you may begin more scar tissue work on your perineal scar. As the scar heals and the pain lessens, you may start feeling more comfortable having sex again.

Perineal scar massage is a great non-surgical way to help with healing and relief for perineal scars. By understanding your body and being patient, you can regain control of your healing process.

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