An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. A midline (median) incision (shown at left) is done vertically. A mediolateral incision (shown at right) is done at an angle. A midline incision is easier to repair, but it has a higher risk of extending into the anal area. A mediolateral incision offers the best protection from an extended tear affecting the anal area, but it is often more painful and is more difficult to repair.