The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is sutured after delivery.

Its routine use is no longer recommended, as perineal massage applied to the vaginal opening, is an alternative to enlarge the orifice for the baby.

[1] It is also widely practiced in many parts of the world, including Korea, Japan, Taiwan, China, and Spain in the early 2000s.

[6] There are four main types of episiotomy:[7] Traditionally, physicians have used episiotomies in an effort to deflect the cut in the perineal skin away from the anal sphincter muscle, as control over stool (faeces) is an important function of the anal sphincter, i.e. lessen perineal trauma, minimize postpartum pelvic floor dysfunction, and as muscles have a good blood supply, by avoiding damaging the anal sphincter muscle, reduce the loss of blood during delivery, and protect against neonatal trauma.

Since about the 1960s, routine episiotomies have been rapidly losing popularity among obstetricians and midwives in almost all countries in Europe, Australia, Canada, and the United States.

[15] Damage to the anal sphincter caused by episiotomy can result in fecal incontinence (loss of control over defecation).

[16] One study found that women who underwent episiotomy reported more painful intercourse and insufficient lubrication 12–18 months after birth but did not find any problems with orgasm or arousal.

Nonpharmacologic interventions can also be used: a warm salt bath increases blood flow to the area, decreases local discomfort, and promotes healing.