I did perineal massage faithfully during my last pregnancy.
I had had three episiotomies with my three previous deliveries and wanted to avoid one desperately, but was afraid of tearing. My OB swore that if I didn't have an episiotomy, I would tear because of the existing scar tissue.
My Doula was wonderful in encouraging me to do the massage and insist in my birthplan that I would prefer to tear.
Well, I labored the baby down on my own, with self-directed pushing, before the doctor even came into the room. By the time the doctor arrived, she was already crowning, and emerged in two pushes (one contraction).
I did tear, but only slightly -- and the only reason I tore, was because there was a compound presentation -- her hand was lying up by her cheek!! I hate to imagine what that presentation would have done, had I not done perineal massage!!! Especially with scar tissue present!!! In fact, my tear was on the inside of my vaginal wall, on the left side -- **nowhere** near the bottom of my vagina, where the episiotomies had been performed!! No tear there at all!!!
And the tear didn't hurt at all during the healing process. In fact, I was sitting up in bed within minutes after the birth -- I couldn't sit for two weeks following my episiotomies!! What a difference!!