Episiotomy is a surgical procedure that involves cutting the perineum (skin between the vagina and the anus) during labor to enlarge the vaginal opening. The procedure is intended to prevent vaginal tears during delivery..

Episiotomies were once routinely performed in an attempt to prevent tearing during labor, particularly to avoid tears that reach to the anus. The number of episiotomies performed remains high in the U.S., but there is now a great deal of controversy over whether they should be routine. Recent studies have shown that women who do not have an episiotomy might have a small tear, which is in most cases not worse than an episiotomy.

To perform an episiotomy, local anesthesia (numbing just the immediate area) is usually used. Just before the baby is born, the obstetrician makes an incision at the bottom of the vaginal opening. This enlarges the vaginal opening. The incision is closed after the baby and placenta have been delivered.

An episiotomy usually heals without problems and may heal more quickly than a tear. It is also thought to help prevent vaginal stretching and to tighten the vagina after delivery. One aspect of episiotomy is the long term consequences. There is no evidence that having an episiotomy increases the risk of painful intercourse. One potential benefit of an episiotomy is that it helps repair the stretching of the tissues that occurs during childbirth. This may very well help prevent the herniation (lack of support) of the vaginal wall later in life. Lack of support of the vaginal tissues can lead to cystoceles, rectoceles, and stress urinary incontinence.