A Cochrane review included four studies with a total of 2 497 subjects. All studies were of good quality. Antenatal perineal massage during the last month of pregnancy undertaken by the woman or her partner was associated with an overall reduction in the incidence of trauma requiring suturing (RR 0.91, 95% CI 0.86 to 0.96; NNT 15 [10 to 36]; 4 studies, n=2480) and women practicing perineal massage were less likely to have an episiotomy (RR 0.84, 95% CI 0.74 to 0.95; NNT 21 [12 to 75]; 4 studies, n=2480). The reductions were statistically significant for women without previous vaginal birth only. No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who had previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (RR 0.45, 95% CI 0.24 to 0.87; NNT 13 [7 to 60]; 1 study, n=376). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus between the groups.