Skip to main content

Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial


Introduction and hypothesis

The aim of this study was to evaluate the effectiveness of perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) prevention educational program in pregnant women above the age of 35 years to prevent perineal tear and episiotomy.


A randomized parallel assignment study involved two groups of pregnant women at the obstetrics outpatient clinic 4 weeks prior to their due date. The first group (n = 200) was educated to do digital perineal massage and pelvic floor muscle training and received an educational PFD prevention program. The second group (n = 200) received only the prevention education program. Occurrence of perineal laceration was reported at time of delivery as a primary outcome. Statistical analysis was done using the IBM SPSS computer program (Statistical Package for the Social Sciences; IBM Corp, Armonk, NY, USA), release 22 for Microsoft Windows.


Delivery was significantly less complicated by perineal tear, episiotomy and postnatal pain in the first than in the second group (p < 0.05). Grades of perineal tear were mostly of first and second degree in the first group compared with the second group. We found a significantly lower need for analgesia and fewer ampoules required during the hospital stay in the first group (p < 0.001, 0.002, respectively).


Performing antenatal digital perineal massage and PFMT in addition to health education is recommended to reduce perineal complications.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Larbi KT, Buchmann EJ, Matshidze PR. Pregnancy outcomes in urban black South African women aged 35 years and older. J Obstet Gynaecol. 2000;20(3):259–62.

    CAS  Article  PubMed  Google Scholar 

  2. Andrews V, Thakar R, Sultan AH, Jones PW. Evaluation of postpartum perineal pain and dyspareunia—a prospective study. Eur J Obstet Gynecol Reprod Biol. 2008;137(2):152–6.

    Article  PubMed  Google Scholar 

  3. Torrisi G, Minini G, Bernasconi F, Perrone A, Trezza G, Guardabasso V, et al. A prospective study of pelvic floor dysfunctions related to delivery. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):110–5.

    Article  PubMed  Google Scholar 

  4. Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeili-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Family Reprod Health. 2016;10(3):115.

    PubMed  PubMed Central  Google Scholar 

  5. de Castro Monteiro MV, Pereira GMV, Aguiar RAP, Azevedo RL, Correia-Junior MD, Reis ZSN. Risk factors for severe obstetric perineal lacerations. Int Urogynecol J. 2016;27(1):61–7.

    Article  Google Scholar 

  6. King TL, Pinger W. Evidence-based practice for intrapartum care: the pearls of midwifery. J Midwifery Womens Health. 2014;59(6):572–85.

    Article  PubMed  Google Scholar 

  7. Zare O, Pasha H, Faramarzi M. Effect of perineal massage on the incidence of episiotomy and perineal laceration. Health. 2014;6(01):10.

    Article  Google Scholar 

  8. McLennan MT, Melick CF, Alten B, Young J, Hoehn MR. Patients’ knowledge of potential pelvic floor changes associated with pregnancy and delivery. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(1):22–6.

    Article  PubMed  Google Scholar 

  9. Dame J, Neher J, Safranek S. Does antepartum perineal massage reduce intrapartum lacerations? J Fam Pract. 2008;57(7):480–2.

  10. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and fecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2017;12:CD007471. Review.

    Article  PubMed  Google Scholar 

  11. Dönmez S, Kavlak O. Effects of prenatal perineal massage and Kegel exercises on the integrity of postnatal perine. Health. 2015;7(04):495.

    Article  Google Scholar 

  12. Abd H. Effects of prenatal perineal massage and Kegel exercise on the episiotomy rate. IOSR-JNHS. 2015;4(4):61–70.

    Google Scholar 

  13. DeFrances CJ, Hall MJ. 2002 national hospital discharge survey. Adv Data. 2004;342(342):1–29.

    Google Scholar 

  14. Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG Int J Obstet Gynaecol. 2016;123(5):745–53.

    CAS  Article  Google Scholar 

  15. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Altman D, Falconer C, Rossner S, Melin I. The risk of anal incontinence in obese women. Int Urogynecol J. 2007;18(11):1283–9.

    Article  Google Scholar 

  17. Voldner N, Frøslie KF, Haakstad LAH, Bø K, Henriksen T. Birth complications, overweight, and physical inactivity. Acta Obstet Gynecol Scand. 2009;88(5):550–5.

    Article  PubMed  Google Scholar 

  18. Lindholm ES, Altman D. Risk of obstetric anal sphincter lacerations among obese women. BJOG Int J Obstet Gynaecol. 2013;120(9):1110–5.

    CAS  Article  Google Scholar 

  19. Eogan M, Daly L, O’Herlihy C. The effect of regular antenatal perineal massage on postnatal pain and anal sphincter injury: a prospective observational study. J Matern Fetal Neonatal Med. 2006;19(4):225–9.

    Article  PubMed  Google Scholar 

  20. Karaçam Z, Ekmen H, Çalişir H. The use of perineal massage in the second stage of labor and follow-up of postpartum perineal outcomes. Health care for women international. 2012;33(8):697–718.

    Article  PubMed  Google Scholar 

  21. Dias LA, Driusso P, Aita DL, Quintana SM, Bø K, Ferreira CH. Effect of pelvic floor muscle training on labor and newborn outcomes: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2011;15(6):487–93.

    Article  PubMed  Google Scholar 

  22. Johanson R. Perineal massage for prevention of perineal trauma in childbirth. Lancet. 2000;355(9200):250–1.

    CAS  Article  PubMed  Google Scholar 

  23. Geranmayeh M, Habibabadi ZR, Fallahkish B, Farahani MA, Khakbazan Z, Mehran A. Reducing perineal trauma through perineal massage with Vaseline in second stage of labor. Arch Gynecol Obstet. 2012;285(1):77–81.

    Article  PubMed  Google Scholar 

  24. Bodner-Adler B, Bodner K, Mayerhofer K. Perineal massage during pregnancy in primiparous women. Int J Gynecol Obstet. 2002;78(1):51–3.

    CAS  Article  Google Scholar 

  25. WHO Reproductive Health Library. WHO recommendation on episiotomy policy (February 2018). The WHO Reproductive Health Library. World Health Organization, Geneva.

  26. Beckmann MM, Stock OM. Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. 2013;4:CD005123. Review.

    Article  Google Scholar 

  27. Labrecque M, Eason E, Marcoux S. Randomized trial of perineal massage during pregnancy: perineal symptoms three months after delivery. Am J Obstet Gynecol. 2000;182(1):76–80.

    CAS  Article  PubMed  Google Scholar 

  28. Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. 2008;10(7):499.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Amira S. Dieb.

Ethics declarations

Conflicts of interest


Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dieb, A.S., Shoab, A.Y., Nabil, H. et al. Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. Int Urogynecol J 31, 613–619 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Pregnancy above 35
  • Episiotomy
  • Health education
  • Pelvic floor muscle training
  • Perineal massage
  • Perineal tear