An episiotomy is an incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth. A midline or median incision (shown at left) is done vertically. A mediolateral incision (shown at right) is done at an angle. A midline incision is the easiest to repair, but 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 is often more painful and might be more difficult to repair.