During pregnancy, you will notice a plethora of changes beyond your growing belly. Throughout pregnancy, you prep your body, mind, and spirit for the journey before you. During the final stages, you may be told by a care provider to begin prepping your body for labor. One specific area is of importance during this time and it starts with a P!
What is the perineum?
Well, it goes by many names…..some less pleasant than others, but essentially it is “the surface region in both males and females between the pubic symphysis and the coccyx.” Approximately 85% of people suffer perineal trauma during vaginal delivery and about 69% require sutures. Tears to the perineum can be minor, though many cause major long term effects that may require surgery and physical therapy. Tears are categorized into 4 degrees of severity:
First-degree tear: laceration is limited to the fourchette (a thin fold of skin at the back of the vulva) and superficial perineal skin or vaginal mucosa (a mucous membrane).
Second-degree tear: laceration extends beyond fourchette, perineal skin and vaginal mucosa to perineal muscles and fascia (a thin sheath of fibrous tissue enclosing a muscle), but not the anal sphincter
Third-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, and anal sphincter are torn; third-degree tears may be further subdivided into three subcategories:
3a: partial tear of the external anal sphincter involving less than 50% thickness
3b: greater than 50% tear of the external anal sphincter
3c: internal sphincter is torn
Fourth-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, anal sphincter, and rectal mucosa are torn.
Now that all of the cringe-worthy details are out of the way, how do we prevent these higher degree tears in normal vaginal delivery?! Obvious tricks include switching up birthing positions to include more movement and comfort during crowning and delivery and submerging genitalia in water to soften skin and muscles during labor. However, the best preventative measure to take would be regular perineal stretching (also called perineal massage) for at least 4-6 weeks leading up to vaginal delivery.
Perineal stretching is one of the top strategies for optimal vaginal delivery . The skin in this area goes through tremendous manipulation during pregnancy and especially during labor (as if I needed to tell you). During pregnancy, the perineum can swell along with the vulva causing minor discomfort, dryness and loss of elasticity. Anti-inflammation products like a 2:1 CBD lube works wonders for this short term issue. Regular (increased to weekly once you hit 38 weeks) perineal massage can keep that precious skin supple and conditioned putting you at your best odds of only needing a stitch here and there or even better NONE AT ALL!
Cannabis-infused lubricants are made with products traditionally used for perineal massage. These oils include coconut oil, shea butter, or sunflower oil. The addition of Cannabis is an added bonus that provides relief from inflammation and muscle fatigue and gives the user a wonderful and tingly sensation. Cannalube is a natural and organic option to water-based lubricants sold in stores and shops around the country.
Foria cannabis lube is the most popular brand when Googling cannalubes, though it is only available in California and Colorado. Arizona has two premium cannalube products available in dispensaries, one by 420Skincare and another by Sublime Skin called Stony Yoni. Depending on your location you may or may not want to create your own. Thankfully, making cannalube is very similar to cannabis massage oil/butter and other topicals. Since it’s so close to cannabis massage oil, making it at home doesn’t require more than a few hours and 7-10 grams of quality flower.
How To “Do It”
When I first bring up perineal massage, everyone in the room looks around and goes “how do you do it?”. Well, thankfully a lot of us have been doing it for a while in the form of foreplay. The technique is a little more deliberate and less focused on sexual pleasure. Sensual pleasure is necessary for the muscles to relax and the massage magic to work, which is why this massage is so beautiful and intimate. Check out this instructional video to see techniques performed on an educational model
For those not in a relationship, you may feel completely out of luck. You’re not! Though it may be hard to find a provider in your area, Yoni Massage is a legitimate industry and many who are trained in the art can also provide perineal massage. Just ask them to focus on that zone. Ask around within your local massage community to see if anyone is a trained Yoni masseuse. You can even ask your midwife or nurse midwife to add this on during cervical checks you have scheduled.
When preparing as a couple for a perineal massage, talking prior is a good idea. Some partners aren’t immediately comfortable with such an intimate massage, especially if it’s predetermined to be sensual, but not sexual. Not every perineal massage will lead to sexual intimacy and that is okay! Decide on a length of time and have a warm towel nearby to signal the end of the session. If it does lead to sex HUZZAH! Sex during pregnancy is fantastic and a great start to a healthy labor.
Perineal tips and tricks
Wear medical gloves. Not only do they provide slip with minimal oil, clean up is a breeze. If you aren’t into gloves, clean, well oiled hands and fingers only!
Perineal stretching isn't always comfortable as pressure is necessary to stretch and relax the skin and muscles but it should never hurt. As skin and muscle relaxation, the area will soften so take your time.
Start slow and steady. Don't try to DJ your pregnant partner with your fingers. Continuous repetitive and rhythmic movement is best. I like to describe this massage as similar to clay work. Steady, gentle, deliberate movements.
Put a time limit on massage. Branch out to other areas as over manipulation can lead to fatigue and soreness later. No bueno!
Have fun! Giggle, exhale, and enjoy!